Reported Symptoms Of Stress Urinary Incontinence Research Articles

Prevalence of stress urinary incontinence symptoms and their impact on the quality of life of Palestinian women: the first large cross-sectional study among the general population

BackgroundLittle studies were conducted to assess the prevalence of stress urinary incontinence among Palestinian women. This study was conducted to determine the prevalence of stress urinary incontinence symptoms, their impact on the quality of life, and the risk factors that were associated with stress incontinence symptoms among Palestinian women.MethodsThis study was conducted in a cross-sectional design from 2023 to 2024. The data were collected through an interviewer-administered questionnaire. The questionnaire collected the demographic and health characteristics of the women. Additionally, the questionnaire also contained the PRAFAB questionnaire (PRAFAB-Q). Moreover, the questionnaire included the Assessment of Quality of Life (AQoL)-8D scale.ResultsData were collected from 386 Palestinian women (response rate = 85.8%). The mean age of women in this study was 37.1 ± 14.7 years. In this study, 104 (26.9%) reported stress urinary incontinence symptoms. Of the women, 102 (26.4%) reported urinary leakage during coughing, 100 (25.9%) reported urinary leakage during sneezing, and 94 (24.4%) reported urinary leakage during laughing. The women who had a family history of stress incontinence were 2.5-fold (95% CI: 1.2–5.2) more likely to have stress incontinence symptoms compared to the women who did not have a family history of stress incontinence. Similarly, the women who were overweight/obese were 2.0-fold (95% CI: 1.1–3.7) more likely to have stress incontinence symptoms compared to the women who were underweight or had a normal weight. PRAFAB-Q scores were predicted by place of residence, family history of stress incontinence, and being recruited from a hospital.ConclusionThe study reported a high prevalence of stress urinary incontinence and identified the risk factors that were associated with stress incontinence symptoms among Palestinian women. The findings showed that the intensity of stress urinary incontinence symptoms was associated with deteriorated quality of life of the affected women. These findings could be used by urologists, gynecologists, obstetricians, and other healthcare providers caring for women to design ways to reduce the burden of stress urinary incontinence among Palestinian women and improve their quality of life.

Efficacy of Top Flat Magnetic Stimulation Technology for Female Stress and Urge Urinary Incontinence: A Clinical Evaluation

Background: Urinary incontinence (UI) is a popular problem with a broad range of severities and etiology. This study evaluates the effectiveness and safety of a device based on top flat magnetic stimulation to manage women affected by urge urinary incontinence (UUI) and stress urinary incontinence (SUI). Methods: Eighty-one female patients (35 patients who reported SUI symptoms and 46 patients who reported UUI symptoms) underwent a total of eight treatments sessions performed twice a week for 4 consecutive weeks, for 28 min. Immediately before each treatment and up to 3 months of follow-up, two questionnaires (Incontinence Impact Questionnaire-Short Form (IIQ-7) and Incontinence Questionnaire Overactive Bladder Module (ICIQ-OAB)) were used. Results: ICIQ-OAB’s average score significantly decreased (P < 0.05) from 10.54 ± 3.03 at baseline to 5.45 ± 2.24 at 3 months follow-up. IIQ-7’s average score significantly decreased (P < 0.05) from 15.53 ± 5.62 at baseline to 6.76 ± 3.10 at 3 months follow-up. Conclusions: For all women examined, protocols used led to a decrease of SUI/UUI complaints, achieving good results and improving patients’ quality of life (QOL) without risk. World J Nephrol Urol. 2022;11(1):18-23 doi: https://doi.org/10.14740/wjnu432

Cough stress tests to diagnose stress urinary incontinence in women with pelvic organ prolapse with indication for surgical treatment.

AimsTo evaluate the diagnostic ability of different cough stress tests (CSTs) in women with pelvic organ prolapse (POP), performed during outpatient urogynaecological exams.MethodsProspective, multicentre observational study involving women on waiting lists for POP surgery. With a subjectively full bladder, patients were asked to perform five different CSTs: without prolapse reduction ([a] standing, followed by [b] semilithotomy position); keeping semilithotomy position with prolapse reduced (by [c] posterior speculum, followed by [d] pessary); [e] standing again with the pessary in place. Primary outcome was positive CST in at least one of the five CSTs. Bladder volume was measured and symptoms of stress urinary incontinence (SUI) were detected by two validated questionnaires.ResultsA total of 297 women completed all CSTs and were included in the analyses. Mean (SD) age, parity, and body mass index were 64.8 (9.9) years, 2.7 (1.3) deliveries, and 26.6 (3.4) kg/m2, respectively. In total, 99 women (33.3%) reported SUI symptoms. At least one positive CST was recorded in 152 patients (51.1%), and in 90 (59.2%) of these 152, a positive CST was observed only when POP was reduced (occult SUI). The CST was positive in 92 (92.9%) of the 99 patients with coexisting SUI symptoms and in 60 (30.3%) of the 205 asymptomatic patients. The percentage of patients with a positive CST was significantly lower when bladder volume was <200 mL vs ≥200 mL (P = .046).ConclusionsThe identification of urinary leakage cases with CSTs is best achieved using multiple different patient positions, different prolapse reduction methods, and bladder volumes ≥200 mL.

The natural history of urinary incontinence subtypes in the Nurses’ Health Studies

Urinary incontinence subtypes often differ by symptom severity and treatment profiles; in particular, mixed urinary incontinence is generally associated with worse symptoms and less successful treatment. Yet, limited information exists on the natural history of different urinary incontinence subtypes, which could help to better identify and treat patients prior to development of more intractable disease. To evaluate the onset of urinary incontinence subtypes, and transitions between subtypes over 8 years, using 2 large cohorts of middle-aged and older women with incident urinary incontinence. We identified 10,349 women with incident urinary incontinence (stress, urgency, and mixed subtypes) from the Nurses' Health Study and the Nurses' Health Study II who were 41-83 years of age, using repeated mailed questionnaires. We defined stress urinary incontinence as leakage with coughing, sneezing, or activity; urgency urinary incontinence as urine loss with a sudden feeling of bladder fullness or when a toilet was inaccessible; and mixed urinary incontinence when women reported that stress and urgency symptoms occurred equally. In subsequent questionnaires 4 and 8 years later, we continued to track symptom severity and subtypes. In addition, to obtain predicted probabilities of urinary incontinence subtypes 4 years and 8 years after urinary incontinence onset, we used multivariable-adjusted generalized estimating equations with a multinomial outcome. At urinary incontinence onset in 2004-2005, 56% of women reported stress urinary incontinence symptoms, 23% reported urgency urinary incontinence symptoms, and 21% reported mixed urinary incontinence symptoms. Women with stress urinary incontinence or urgency urinary incontinence at onset were likely to report the same urinary incontinence type 4 and 8 years later (stress urinary incontinence at onset: 70% and 60% reported stress urinary incontinence at years 4 and 8, respectively; urgency urinary incontinence at onset: 68% and 64% reported urgency urinary incontinence at years 4 and 8, respectively). Nonetheless, for both stress and urgency urinary incontinence, women with more severe symptoms at onset were more likely to progress to mixed urinary incontinence. Women with mixed urinary incontinence at onset had more variation over time, although the largest subset continued to report mixed urinary incontinence (45% reported mixed urinary incontinence at year 4; 43% reported mixed urinary incontinence at year 8). Few women across all urinary incontinence subtypes reported resolution of symptoms over 4-8 years of follow-up (4-12%). When considering the likelihood of remaining with or progressing to mixed urinary incontinence over follow-up, according to age, body mass index, and urinary incontinence severity, we found that older and younger women had similar predicted probability of remaining with or progressing to mixed urinary incontinence (eg, women <60 years of age at onset with severe mixed urinary incontinence had a 54% (95% confidence interval, 53-55) probability of mixed urinary incontinence 8 years later, vs 57% (95% confidence interval, 56-58) of women ≥70 years of age with severe mixed urinary incontinence at onset). Obese women were somewhat more likely to progress to mixed urinary incontinence regardless of urinary incontinence type at onset (eg, women with body mass index <25 kg/m2 at onset with severe stress urinary incontinence had a 30% predicted probability of mixed urinary incontinence 8 years after onset, vs 36% of women with body mass index of 30+ kg/m2 at onset with severe stress urinary incontinence). Most women with incident stress and urgency urinary incontinence continued to experience similar subtype symptoms over 8 years. However, obese women and those with more severe symptoms were more likely to remain with or progress to mixed urinary incontinence.

The negative predictive value of preoperative urodynamics for stress urinary incontinence following prolapse surgery.

There is no consensus for the evaluation of stress urinary incontinence (SUI) in patients planning pelvic organ prolapse (POP) surgery. We sought to determine the negative predictive value (NPV) of prolapse reduction during preoperative urodynamics (UDS) for postoperative SUI. We performed a retrospective study of 322 women with preoperative UDS and subsequent POP surgery. Abstracted data included demographics, prolapse stage, prior prolapse or incontinence surgery, preoperative SUI complaint, prolapse reduction method, and length of follow-up. Any woman who reported SUI symptoms within 6months from surgery was considered a diagnostic UDS failure. The NPV was calculated by dividing the number of patients who did not demonstrate SUI on UDS and had no postoperative SUI by the number of patients who did not demonstrate SUI on UDS. Patient characteristics (age, race, parity, prolapse stage, prior surgery, and length of follow-up) were similar among those who had urodynamic-proven SUI and those who did not. The NPV of preoperative UDS for postoperative SUI in patients undergoing any POP repair was 97.9.0% [95% confidence interval (CI) 92.7-99.7%]. The NPV remained high in the subset of patients who underwent an apical suspension-98.6% (95% CI 92.7-100.0%)-as well as those without a preoperative SUI complaint-98.6% (95% CI 92.3-100.0%). In most patients (72.9%), a ring pessary with support combined with intraprocedural manipulation allowed for reliable stress testing. Our study supports using preoperative UDS as a screening tool to avoid unnecessary concomitant continence procedures. Further studies are needed to individualize patient preoperative assessment and surgical counseling.

Effect of Morbid Obesity on Midurethral Sling Efficacy for the Management of Stress Urinary Incontinence.

The aim of our study was to assess midurethral sling (MUS) failure rate in the morbidly obese (body mass index [BMI] ≥40 kg/m) population as compared with normal-weight individuals. Our secondary objective was to assess the difference in complication rates. This is a retrospective cohort study. We included all patients who underwent a synthetic MUS procedure from January 1, 2008, to December 31, 2015, in our health system. Failure was defined as reported stress urinary incontinence symptoms or treatment for stress urinary incontinence. Variables collected were BMI; smoking status; comorbidities; perioperative (≤24 hours), short-term (≤30 days), and long-term (>30 days) complications; and follow-up time. Statistics include analysis of variance, χ test, logistic regression, Kaplan-Meier method, and Cox regression. There were 431 patients included in our analysis. Forty-nine patients were in class 3 with a BMI mean of 44.9 ± 5.07 kg/m. Median follow-up time was 52 months (range, 6-119 months). Class 3 obesity (BMI ≥40 kg/m) was the only group that had an increased risk of failure when compared with the normal-weight group (P = 0.03; odds ratio, 2.47; 95% confidence interval, 1.09-5.59). Obesity was not a significant predictor of perioperative, short-term, or long-term postoperative complications (P = 0.19, P = 0.28, and P = 0.089, respectively) after controlling for other comorbidities. Patients in the class 3 obesity group who are treated with an MUS are 2 times as likely to fail when compared with those in the normal-weight category on long-term follow-up with similar low complication rates.

Long-term outcomes after the excision of horseshoe urethral diverticulum

The objective was to report our long-term experience with horseshoe urethral diverticulum (HUD) excised using the urethral preservation technique. Following IRB approval, charts of women who underwent HUD excision and had at least 6 months' follow-up were reviewed. HUD was defined as a bilateral posterior diverticulum that extended laterally and anteriorly past 3 and 9 o'clock on the left and right sides respectively. HUD was diagnosed by pre-operative MRI. Success was defined as no evidence of residual diverticulum on post-operative imaging and the reported resolution of diverticulum symptoms. Between 1998 and 2014, 12 out of 15 women who underwent HUD excision met the inclusion criteria. Mean follow-up was 81 (median: 52, range: 7-163) months. Presenting symptoms included urinary leakage (n = 8), dyspareunia (n = 6), dysuria (n = 6), frequency (n = 5), urgency (n = 5), and vaginal pain (n = 8). Two patients reported having all three symptoms of the historic triad: dysuria, dyspareunia, and post-void dribbling. Three patients had prior urological interventions, including excision of a unilateral diverticulum, a Spence procedure, and a Skene gland incision. Only 1 patient had a recurrent HUD confirmed by MRI 10 years later, which required reoperation. HUD symptoms resolved in the remaining 11 patients, with post-operative imaging showing no evidence of recurrent HUD, and no further therapy was needed. Of 4 women who reported stress urinary incontinence (SUI) pre-operatively, only 2 reported SUI symptoms post-operatively. There were no cases of post-operative urethro-vaginal fistula. At a mean follow-up of 6-7 years, excision of HUD with urethral preservation produced long-lasting resolution in the majority of patients.