Risk Factors For Incontinence Research Articles

Fecal incontinence risk factors and pregnancy.

We conducted an analysis on 231 pregnant women. A proctologist examined the patients three times: in the 1st trimester (within the first 15 weeks), in the 3rd trimester (29-40 weeks), and 12 months after childbirth. The total number of fecal incontinence observations among women included in the study was 66 cases (28.6%), detected at the final visit. Risk factors for fecal incontinence with a high probability were age over 36 years (P = 0.001), low physical activity (P = 0.034), three or more pregnancies resulting in childbirth (P = 0.022), history of hemorrhoids (P = 0.027), perianal discomfort on the first visit (P = 0.045), and constipation on the first visit (P = 0.006). Factors such as being overweight, marital status, education, living conditions, living area, and infant size did not have significance for fecal incontinence. Pregnancy- and obstetric-related risk factors contributing to fecal incontinence are multifactorial, including factors such as multiple childbirths with trauma to the pelvic muscles or anal sphincter muscles, chronic constipation, age, and vaginal deliveries. However, currently, there is no clear concept for the prevention of fecal incontinence in pregnant women. The prevalence of fecal incontinence among pregnant women is 12.9%, which increases to 28.6% one year after childbirth. The most common complaint was involuntary passage of intestinal gas. Risk factors for fecal incontinence with a high probability included being over 36-years old, low physical activity, three or more pregnancies resulting in childbirth, a history of hemorrhoids, perianal discomfort, and constipation in the 1st trimester of pregnancy.

Incidence of and risk factors for new-onset urinary and fecal incontinence after acute stroke

Background:Understanding the risk factors for incontinence after acute stroke allows for early identification and treatment of patients who are likely to experience this complication. Objectives:The purpose of this study was to estimate the incidence of urinary and fecal incontinence (UI and FI) after stroke in adults and examine the association of risk factors. Methods:Screening data from a prospective study were analyzed. Included were 652 consecutive patients admitted to an acute stroke unit over a 15-month period beginning May 2021. Those with pre-existing UI or FI were excluded from the analysis. Bivariate analyses examined unadjusted relationships between both UI and FI and age, sex, stroke severity, premorbid disability, stroke type, and stroke anatomical site. Regression analyses were performed to build iterative models. Results:A total of 418 patients had an acute stroke without pre-existing incontinence. The median age of stroke survivors was 76 years (IQR 66–84), 58% were men, and 76% had an ischemic stroke. Within the first 7 days after stroke, 128 (29%) had UI and 115 (26%) had FI. Increasing age, premorbid disability, and stroke severity increased the risk of both new-onset UI and FI after stroke. Those with intraventricular hemorrhage were 2.9 times more likely to develop UI. Women were 1.7 times more likely to have UI after stroke than men. Intraventricular hemorrhage increased the risk of new-onset FI after stroke by 2.9 times, while lobar hemorrhage increased the risk by 2.2 times. Conclusions:Urinary and fecal incontinence continue to be relatively common after acute stroke, although incidence rates are lower than 20th century estimates. Patients are more likely to require incontinence assessment, monitoring and care if they are older, had higher premorbid disability, and have experienced more severe stroke or intraventricular hemorrhage. Given that more than a quarter of stroke patients develop incontinence following stroke, continence care and rehabilitation programs remain essential components of stroke services.

Pelvic floor muscle training with biofeedback or feedback from a physiotherapist for urinary and anal incontinence after childbirth - a systematic review

BackgroundChildbirth is one of the biggest risk factors for incontinence. Urinary and anal incontinence can cause pain and social limitations that affect social life, cohabitation, and work. There is currently no up-to-date literature study on the effect of pelvic floor muscle training with feedback from a physiotherapist, which involves verbal instructions based on vaginal and anal digital palpation, compared to treatment without feedback (e.g., recommendations for pelvic floor muscle training).AimThe objective of this systematic review was to examine the scientific evidence regarding the impact of pelvic floor muscle training (PFMT) with feedback from a physiotherapist and/or biofeedback on urinary and anal incontinence in women during the first six months following vaginal delivery, compared to treatment without feedback.MethodsThe literature search was conducted in the databases PubMed, Cochrane, and CINAHL. In addition, a manual search was conducted. The search terms consisted of MeSH terms and synonyms in the respective search block including population, intervention, and study design, as well as the terms pelvic floor and postpartum. An evaluation of each included study was conducted for methodological quality, evidence value, and clinical relevance.ResultsEight studies were included, three of which showed a significant difference between groups, in favor of the intervention group that received pelvic floor muscle training with feedback from a physiotherapist and/or biofeedback. Due to the varying results and insufficient quality for the majority of the studies, the scientific basis was considered insufficient.ConclusionThe scientific evidence for pelvic floor muscle training with feedback from a physiotherapist or biofeedback on postpartum urinary and anal incontinence compared to treatment without feedback is considered insufficient. Further research on the subject is needed. The study is registered in PROSPERO CRD42022361296.

Prevalence of pelvic floor dysfunction and associated risk factors among Nulligravida college students: a cross-sectional study

BackgroundPelvic floor dysfunction (PFD) is a global health problem affecting millions of women worldwide. Vaginal childbirth has been reported to be the most important factor in the etiology of PFD though a prior study also reported a high prevalence of PFD in nulliparous women. Some previous studies had suggested Urinary incontinence before pregnancy as a major risk factor for incontinence later in life, thus prevention of PFD has become a major priority in women’s health, and identification of women at risk is a key element in current prevention strategies It is therefore necessary to investigate the prevalence and risk factors for PFD in Nulligravida women who have never been pregnant to enable preventative measures especially as it regards lifestyle modification.MethodsParticipants were 160 Nulligravida students aged between 17 and 26 years. They were screened for pelvic floor dysfunction using an Australian pelvic floor questionnaire which assessed their bladder function, bowel function, pelvic organ prolapse, and sexual function. Descriptive statistics of frequency and percentage were used to summarize categorical variables. Univariate analysis of Fisher’s exact test and Wilcoxon rank-sum test were conducted to show the association of categorical and continuous variables with pelvic floor dysfunction (PFD) respectively. The risk factors of PFD with p values < 0.05 were considered significant. All analyses were performed using R Statistical Computing Programming version 4.2.2.ResultsThe prevalence of having at least one of any of the PFD was 73.1% while the prevalence of bladder, bowel, prolapse, and sex dysfunction were 25.63% (41/160), 53.75% (86/160), 1.88% (3/160), and 23.13% (37/160) respectively. BMI was not a significant risk factor for any type of PFD while multi-variable logistic regression identified the level of study, height, history of UTI, and non-sport participation as significant (p < 0.05) risk factors for at least one type of PFD with Odd ratio of 4.91, > 100, 8.47, and 2.86 respectively.ConclusionThere is high prevalence of PFD among Nulligravida students, with non-participation in sports and history of urinary tract infections being the main significant risk factors.

Prevalence and associated risk factors of urinary incontinence among menopausal women living in rural area

Background: Urinary incontinence is social plus hygiene problem. It is one of the common symptoms attributable to hormonal changes during menopause which significantly affects quality of life of women. This study was aimed to estimate the prevalence, risk factors of urinary incontinence and its impact on everyday activities.&#x0D; Method: This study was carried out in rural areas of Ahmednagar district. Two hundred women above 40 years of age were included. Incontinence was assessed using international consultation on incontinence questionnaire.&#x0D; Results: Statistical analysis was done using spss, where the mean was 48.12±8.9 years, one hundred thirteen females were postmenopausal and eighty-seven were premenopausal.&#x0D; Conclusion: A moderate prevalence of urinary incontinence among rural area. Multi parity, occupation, hysterectomy, comorbidities were identified risk factors for incontinence. Significant difference was found in occupation, comorbidities, parity and hysterectomy in studied population

Association between calf circumference and incontinence in Chinese elderly

BackgroundThe objective of this study was to analyze the association between calf circumference and incontinence in Chinese elderly, and to find out the maximal cut-off point by gender for the use of calf circumference in screening for incontinence.MethodsIn this study, participants were from the 2018 Chinese Longitudinal Healthy Longevity Survey (CLHLS). The maximal calf circumference cut-off point and other incontinence-related risk factors were explored using receiver operating characteristic (ROC) curves and logistic regression analysis.ResultsThe study included 14,989 elderly people (6,516 males and 8,473 females) over 60. The prevalence of incontinence in elderly males was 5.23% (341/6,516), significantly lower than females, which was 8.31% (704/8,473) (p < 0.001). There was no correlation between calf circumference < 34 cm in males and < 33 cm in females and incontinence after adjusting the confounders. We further stratified by gender to predict incontinence in elderly based on the Youden index of ROC curves. We found the association between calf circumference and incontinence was the strongest when the cut-off points were < 28.5 cm for males and < 26.5 cm for females, with an odds rate (OR) value of 1.620 (male, 95%CI: 1.197–2.288) and 1.292 (female, 95%CI: 1.044–1.600) after adjusting the covariates, respectively.ConclusionsOur study suggests that calf circumference < 28.5 cm in males and < 26.5 cm in females is a risk factor for incontinence in the Chinese elderly population. Calf circumference should be measured in routine physical examination, and timely interventions should be made to reduce the risk of incontinence in subjects with calf circumference less than the threshold.

Prevalence and Risk Factors for Urinary Incontinence in Nulliparous Women: A Contemporary, Population-Based Cohort Study.

Epidemiologic studies of incontinence largely focus on parous women, and there are limited data regarding nulliparous women. Our objectives were to evaluate risk factors for urinary incontinence among a nationally representative, contemporary sample of nulliparous women of all ages in the United States and to describe the prevalence and subtypes of urinary incontinence and nocturia in this population. This cross-sectional, population-based study used the National Health and Nutrition Examination Survey cycles 2011-2018 to assemble a sample of nulliparous women 20-80 years old. Crude and adjusted odds ratios were estimated using multivariable logistic regression for the exposures of interest: body mass index (BMI), age, physical activity, prior hysterectomy, and current smoking. Prevalence of urinary incontinence and nocturia were estimated. Among 1,603 nulliparous women, prevalence of any urinary incontinence was 29.38%. Prevalence of stress, urgency, and mixed urinary incontinence and nocturia, respectively, were 27.68%, 19.64%, 10.57%, and 58.95%. Women with a BMI ≥25 (calculated as weight in kilograms divided by height in meters squared; adjusted odds ratio [aOR], 1.57; 95% confidence interval [CI], 1.11-2.23), at least 45 years (aOR, 3.75; 95% CI, 2.31-5.83), and current smoking (aOR, 1.63; 95% CI, 1.07-2.49) had increased the odds of incontinence compared with women without these risk factors. When stress urinary incontinence (SUI) was considered alone, only women with a BMI ≥25 (aOR, 1.66; 95% CI, 1.20-2.31) and age at least 45 years (aOR, 3.17; 95% CI, 2.01-5.00) had increased odds of SUI compared with women without these risk factors. Urinary incontinence and nocturia are prevalent in nulliparous women, and age, elevated BMI, and current smoking may represent risk factors for incontinence in this population.

Prediction of Incontinence after Robot-Assisted Radical Prostatectomy: Development and Validation of a 24-Month Incontinence Nomogram.

Simple SummaryMany men fear urinary leakage after radical surgery for prostate cancer and may even choose against operation for unrealistic fears of leakage. Many urologists are unaware of their own results, and some urologists who collect their results do so in different ways. We collected urinary leakage data from 680 men in a uniform and simple way at 6, 12, and 24 months after operation: no pads, 1–2 pads, or ≥3 pads required daily. We used many patient characteristics to identify the key factors that predict recovery of urinary control after operation: age, race, height and weight, and preoperative erectile function. Easy-to-use nomograms were constructed that should be tested by other urologists to make sure they perform equally well in their patients. Nomograms like these allow men and the urologists counseling them to share patient-specific information about the timeline for, and the chance of, recovery of urinary control after operation.Incontinence after robot-assisted radical prostatectomy (RARP) is feared by most patients with prostate cancer. Many risk factors for incontinence after RARP are known, but a paucity of data integrates them. Prospectively acquired data from 680 men who underwent RARP January 2008–December 2015 and met inclusion/exclusion criteria were queried retrospectively and then divided into model development (80%) and validation (20%) cohorts. The UCLA-PCI-Short Form-v2 Urinary Function questionnaire was used to categorize perfect continence (0 pads), social continence (1–2 pads), or incontinence (≥3 pads). The observed incontinence rates were 26% at 6 months, 7% at 12 months, and 3% at 24 months. Logistic regression was used for model development, with variables identified using a backward selection process. Variables found predictive included age, race, body mass index, and preoperative erectile function. Internal validation and calibration were performed using standard bootstrap methodology. Calibration plots and receiver operating curves were used to evaluate model performance. The initial model had 6-, 12-, and 24-month areas under the curves (AUCs) of 0.64, 0.66, and 0.80, respectively. The recalibrated model had 6-, 12-, and 24-month AUCs of 0.52, 0.52, and 0.76, respectively. The final model was superior to any single clinical variable for predicting the risk of incontinence after RARP.

Real world outcomes of lateral internal sphincterotomy vs botulinum toxin for the management of chronic anal fissures

BackgroundLateral internal sphincterotomy (LIS) remains the gold standard surgical approach for the management of chronic anal fissures (CAF). The procedure however, is complicated by the risk of postoperative incontinence. Intrasphincteric Botulinum Toxin (BT) has gained popularity as an alternative approach, despite being inferior to LIS with regards to cure rates. In the real world, patients at high risk for postoperative incontinence are likely to be offered BT as a preliminary procedure. The aim of this study was to explore the real-world outcomes of LIS and BT for a cohort of CAF patients. Methods251 consecutive patients treated with either BT or LS for CAF by a single surgeon were reviewed. Patients were offered BT as a preliminary procedure if they had risk factors for faecal incontinence, whereas all other patients underwent LIS. Primary outcomes included rates of recurrence and faecal incontinence. ResultsLIS was superior to BT with regards to recurrence rates throughout the mean follow up period of five years (5% vs 15%, p = 0.012). A total of 17 patients experienced a minor degree of flatal incontinence at the 6-week follow up, although there was no difference between LIS and BT (7% vs 6%, p = 1.000). Four LIS patients (2%) continued to experience some minor incontinence to flatus at the 12-month follow up and were managed with biofeedback. ConclusionFor patients with CAF, individualizing the treatment approach according to risk factors for incontinence could mitigate this risk in LIS. High risk patients should be offered BT as a preliminary procedure.

Do future healthcare professionals have adequate knowledge about risk factors for stress urinary incontinence in women?

BackgroundStress urinary incontinence worsens living conditions as far as the occupational, social, mental, physical and sexual aspects of a woman’s life. Despite its real impact on the everyday lives of millions of women around the world, this problem is still disregarded and treated only as a discomfort associated with personal hygiene. Could this be due to negligence on the part of medical personnel in this matter and perhaps this lack of knowledge and proper information intended for women with stress urinary incontinence? Implementing educational activities to increase knowledge about urinary incontinence will translate into better educated women and earlier implementation of urinary incontinence treatment in the future. To properly educate women at risk of urinary incontinence, one needs to be familiar with the condition, in particular the risk factors for its development. The purpose of the study was to evaluate the degree of knowledge of students graduating from medical faculties have regarding risk factors for stress urinary incontinence in women and assess where the students’ knowledge of this problem came from.MethodsThe research involved 1581 final year students of medical faculties: nursing and midwifery (258), medicine (432), physiotherapy (402) and other medical (489). The author’s survey was used for the research. The chi2 test was used for analysis.ResultsStudents in faculties of nursing and midwifery, general medicine, physiotherapy, and other medical faculties could correctly list stress urinary incontinence risk factors in 88.8%, 81.7%, 74.4% and 51.9% of their answers respectively (p < 0.01). The most frequently mentioned source of knowledge about stress urinary incontinence was higher level education in 82.6%, 89.8%, 90.0% and 34.4% of the respective groups’ replies (p < 0.001).ConclusionsNursing and midwifery students had the greatest theoretical knowledge of stress urinary incontinence, and lesser knowledge was found among general medicine students, while physiotherapy students and students of other medical faculties had the least theoretical knowledge about risk factors for urinary incontinence. It is advisable that more emphasis be placed on educating students about stress urinary incontinence due to their insufficient knowledge, in particular for future doctors and physiotherapists who will have direct contact with patients.

Pregnancy- and obstetric-related risk factors for urinary incontinence, fecal incontinence, or pelvic organ prolapse later in life: A systematic review and meta-analysis.

Risk factors for pelvic floor disorders are often related to pregnancy and delivery. Consistent evidence is needed to develop prevention strategies targeting risk factors. The objective of this study is to identify which pregnancy- and/or obstetric-related risk factors can predict urinary incontinence, fecal incontinence, or pelvic organ prolapse later in life by means of a systematic review and meta-analysis. Systematic review Prospero number: CRD42019131758. Literature searches of PubMed, EMBASE, CINAHL, and Cochrane Library were conducted according to PRISMA guidelines (April 2020). Prospective cohort studies describing more than two pregnancy- and/or obstetric-related risk factors on urinary incontinence, fecal incontinence (including flatal incontinence), or pelvic organ prolapse were eligible. Risk of bias was assessed (using Quality In Prognosis Studies [QUIPS]). Studies with high risk of bias were excluded. Data were extracted and checked for accuracy with the CHARMS checklist. Sub-groups were used to distinguish between a short- and long-term follow-up period: <18months (shortterm) and >18months (long-term) postpartum. Odds ratios were calculated from reported prevalence rates. Log odds ratios were calculated using SPSS v.24. Variables were pooled using RevMan5. Data were extracted from nineteen studies for urinary incontinence, nine for fecal incontinence, and two for pelvic organ prolapse. Multivariate analysis was not possible because of the heterogeneity of the population and outcome measures. Pooled univariate risk factors for urinary incontinence were: urinary incontinence during pregnancy, instrumental vaginal delivery, episiotomy, tears, and constipation. Pooled univariate risk factors for fecal incontinence were: fecal incontinence during pregnancy, maternal age over 35years, prenatal body mass index over 30kg/m2 , instrumental vaginal delivery, a spontaneous vaginal delivery, oxytocin augmentation, and when the weight of the newborn was more than 4000g. Both studies for pelvic organ prolapse had a short-term follow-up period and cesarean section was the only risk factor that could be pooled. Pregnancy- and obstetric-related risk factors predicting pelvic floor disorders postpartum are multifactorial and differ between pelvic floor disorders. The strongest risk factor for incontinence later in life was incontinence during pregnancy. Better quality research with long-term follow up is needed on this topic.

Incontinência urinária em idosos da estratégia saúde da família: prevalência e fatores de risco

Objetivos: determinar a prevalência da incontinência urinária (IU) e a sua relação com aspectos sociodemográficos, antropométricos, funcionais e clínicos em idosos da Estratégia Saúde da Família de Porto Alegre/RS (ESF/POA).Métodos: estudo transversal analítico, coletado prospectivamente em amostra aleatória (30 unidades da ESF/POA). Foram coletados dados sociodemográficos, antropométricos e de saúde, sendo aplicados o Questionário Minessota de atividades físicas e de lazer, o Miniexame do Estado Mental, a Escala de Silhuetas de Stunkard (imagem corporal) e testes funcionais (Senta/Levanta, força de preensão manual e velocidade de caminhada).Resultados: foram estudados 575 idosos (68,9±7,1 anos; mulheres= 64,35%) dos quais 33,04% relataram IU (mulheres= 69,5%). Foram estimados como fatores de risco para a IU: menor escore do Miniexame (OR= 0,939; p= 0,033; IC95%= 0,887– 0,995); presença de prejuízo cognitivo (OR= 1,625; p= 0,010; IC95%= 1,351– 3,113); velocidade de caminhada mais lenta (OR= 1,160; p= 0,016; IC95%= 1,028– 1,309); e menor escore no teste Senta/Levanta (OR= 0,013; p= 0,874; IC95%= 0,712 – 0,932). Quedas, atividade física, satisfação com a imagem corporal e ingestão medicamentosa não apresentaram associação significativa com a IU.Conclusão: nessa amostra, foi alta a prevalência da IU. Apresentar menor força de membros inferiores, menor velocidade de caminhada e prejuízo cognitivo foram identificados como fatores de risco para a incontinência, todos modificáveis.

Nationwide survey of continence status among older adult residents living in long-term care facilities in Japan: The prevalence and associated risk factors of incontinence and effect of comprehensive care on continence status.

This study aimed to identify the prevalence of urinary, fecal and double incontinence among Japanese residents aged ≥65 years living in long-term care facilities. Furthermore, the association between baseline characteristics and changes in toileting activity after a 3-month comprehensive care among older individuals was investigated. We examined the prevalence of incontinence and its significant predictors. The association between the Functional Independence Measure score at baseline and each type of incontinence (urinary, fecal or double incontinence) was examined using a logistic regression model. Similarly, the association between the Functional Independence Measure score at baseline and improvement in toileting activity after a 3-month comprehensive care was examined. In total, 2517 residents (670 men and 1847 women) were recruited. The prevalence rates of urinary, fecal and double incontinence were 66.9%, 42.8% and 41.1%, respectively. In multivariate analysis, the sum of the motor subscales after removing four continence items and the sum of the cognitive subscales of the Functional Independence Measure score at baseline were significantly associated with all types of incontinence. The sum of the motor subscales after removing four continence items of the Functional Independence Measure score was associated with improved toileting activity. This study presented the prevalence of urinary, fecal and double incontinence among residents living in long-term care facilities in Japan. The Functional Independence Measure items at baseline were associated with not only continence status, but also improved toileting activity after 3-month comprehensive care. Geriatr Gerontol Int 2020; 20: 285-290.

Urinary dysfunction in patients with rectal cancer: a prospective cohort study.

AimUrinary dysfunction is one of many complications after treatment for rectal cancer. The aim of this study was to evaluate the prevalence of patient‐reported urinary dysfunction at the time of diagnosis and at 1‐year follow‐up and to assess the risk factors linked to urinary incontinence.MethodPatients with newly diagnosed rectal cancer were included in the QoLiRECT study between 2012 and 2015. Questionnaires from the time of diagnosis and 1‐year follow‐up were analysed, with 1085 and 916 patients, respectively, eligible for analysis. Regression analyses were made to investigate possible risk factors for incontinence. The patient cohort was also compared with a cohort from the Swedish general population.ResultsAt baseline, the prevalence of urinary dysfunction (14% of women, 8% of men) was similar to that in the general population. At 1‐year follow‐up, 20% of patients experienced urinary incontinence (29% of women, 14% of men). Emptying difficulties were experienced by 46% (41% of women, 49% of men) and urgency by 58% across both sexes. Abdominoperineal excision and urinary dysfunction at baseline were found to be independent risk factors for incontinence at 1‐year follow‐up. Among patients who were continent at baseline, risk factors were female sex, physical inactivity at baseline, comorbidity and abdominoperineal excision.ConclusionUrinary dysfunction is frequent among patients with rectal cancer, with up to a two‐fold increase in symptoms 1 year after diagnosis. Unfortunately, few factors are modifiable and these results stress the importance of informing patients of possible outcomes related to urinary dysfunction after treatment for rectal cancer.

The Outcome of a Single-Incision Sling versus Trans-Obturator Sling in Overweight and Obese Women with Stress Urinary Incontinence at 3-Year Follow-Up.

Background: Being overweight or obese is a risk factor for incontinence and has negative impacts on the surgical outcomes. Compared with trans-obturator sling (TOS), single incision sling (SIS) is a new generation of anti-incontinence surgery. However, the data on SIS in overweight and obese women remains limited. Methods: This retrospective study analyzed the objective and subjective cure rate of overweight and obese women who underwent sling surgeries. Other evaluations included valid questionnaires to assess quality of life and 1-hour pad test to quantify urine leakage. Surgical characteristics and adverse events were also analyzed. Results: A total of 217 patients were analyzed with a median follow-up period of 37.3 months (range, 9–84 months). For overweight and obese patients, the objective and subjective cure rate were comparable (all p > 0.05). However, the SIS group had worse post-operative incontinence-related symptom distress (p < 0.001) and 1-hour pad test (p = 0.047). On the other hand, SIS had a shorter surgery time (p = 0.017) and lower pain score (p < 0.001). Conclusions: Compared with TOS, SIS had non-significant cure rates in the overweight and obese women. SIS had worse urine leakage and incontinence symptoms, but less surgical and wound pain in obese women. Thorough pre-operative counseling is necessary.

The location of the bladder neck in postoperative cystography predicts continence convalescence after radical prostatectomy

BackgroundThis study was conducted to determine whether the location of the bladder neck in postoperative cystography predicts recovery of continence after radical prostatectomy.MethodsBetween 2008 and 2015, 203 patients who underwent laparoscopic radical prostatectomy (LRP, n = 99) and robot assisted radical prostatectomy (RARP, n = 104) were analyzed. The location of the bladder neck was visualized by postoperative routine cystography, and quantitative evaluation of the bladder neck position was performed according to the bladder neck to pubic symphysis (BNPS) ratio proposed by Olgin et al. (J Endourol, 2014). Recovery of continence was defined as no pad use or one security pad per day. To determine the predictive factors for recovery of continence at 1, 3, 6 and 12 months, several parameters were analyzed using logistic regression analysis, including age (≤68 vs. > 68, BMI (≤23.4 vs. > 23.4 kg/m2), surgical procedure (LRP vs. RARP), prostate volume (≤38 vs. > 38 mL), nerve-sparing technique, vesico-urethral anastomosis leakage, and BNPS ratio (≤0.59 vs. > 0.59).ResultsThe mean postoperative follow-up was 1131 days (79–2880). At 1, 3, 6 and 12 months after surgery, continence recovery rates were 25, 53, 68 and 81%, respectively. Although older age (> 68) and RARP were significant risk factors for incontinence within 3 months, neither was significant after 6 months. A high BNPS ratio (> 0.59) was the only significant risk factor for the persistence of incontinence at all observation points, up to 12 months.ConclusionsA lower bladder neck position after prostatectomy predicts prolonged incontinence.

The Relationship Between Incontinence and Erectile Dysfunction After Robotic Prostatectomy: Are They Mutually Exclusive?

BackgroundUrinary incontinence (UI) and erectile dysfunction (ED) remain the most common long-term complications of prostatectomy, with a significant impact on sexual health and quality of life. AimsTo determine the relation between UI and moderate to severe ED and the risk factors for UI in patients undergoing robotic-assisted laparoscopic prostatectomy. MethodsPatients in our institutional database who underwent robotic-assisted laparoscopic prostatectomy for prostate cancer (2006–2013) and who completed the University of California–Los Angeles Prostate Cancer Index and the Sexual Health Inventory for Men (SHIM) surveys at 12 months after prostatectomy were eligible for inclusion. Men who reported use of no urinary pads per day were considered continent, whereas men who used at least one pad per day were considered incontinent. Men with moderate to severe ED based on a SHIM score no higher than 11 were considered to have ED. Patients who had preoperative moderate to severe ED and/or UI based on these definitions were excluded from further analysis. OutcomesA better understanding of what increases the risk for UI after a prostatectomy and how it can co-occur with ED. ResultsWe analyzed 464 patients who met the inclusion criteria. After prostatectomy, 36% of patients had UI and 47% of patients had moderate to severe ED. Of all patients with ED, 45% (98 of 216) were incontinent compared with 27% (67 of 248) of patients without ED (P < .001). On multivariable analysis, older age at diagnosis (odds ratio [OR] = 1.05, P = .002) and ED (OR = 1.88, P = .005) were independent predictors for incontinence. The use of unilateral nerve sparing (OR = 1.03, P = .94) or no nerve sparing (OR = 0.53, P = .50) during surgery did not have an impact on postoperative incontinence. Clinical ImplicationsUnderstanding that ED is an independent predictor of UI after robotic-assisted laparoscopic prostatectomy has important clinical implications and suggests a common anatomic pathway. Strengths and LimitationsOur focus on different measurements of incontinence and their relation to ED and our use of validated questionnaires to define incontinence and ED were important strengths of this study. Limitations of our study include its retrospective nature and the fact that our results were drawn from a single-center database of a tertiary referral hospital. ConclusionOur results show that the presence of moderate to severe ED after prostatectomy is an independent risk factor for incontinence, suggesting a possible common pathway for these two complications. Further studies to investigate the anatomic and clinical bases of this relation are warranted.Tsikis ST, Nottingham CU, Faris SF. The Relationship Between Incontinence and Erectile Dysfunction After Robotic Prostatectomy: Are They Mutually Exclusive? J Sex Med 2017;14:1241–1247.

Incontinence and associated complications: Is it avoidable?

Continence issues and incontinence is prevalent within the UK with an estimated 14 million adults affected by urinary incontinence ( Bladder and Bowel Community, 2015 ) and over 6.5 million adults suffering with bowel control problems ( NHS England, 2015 ). This article will identify potential risk factors for incontinence; identify the different types of incontinence; outline what a comprehensive continence assessment should include; and outline the potential, and mostly preventable, complications that can occur due to incontinence.

Incontinence and gait disturbance after intraventricular extension of intracerebral hemorrhage.

We tested the hypothesis that intraventricular hemorrhage (IVH) is associated with incontinence and gait disturbance among survivors of intracerebral hemorrhage (ICH) at 3-month follow-ups. The Genetic and Environmental Risk Factors for Hemorrhagic Stroke study was used as the discovery set. The Ethnic/Racial Variations of Intracerebral Hemorrhage study served as a replication set. Both studies performed prospective hot-pursuit recruitment of ICH cases with 3-month follow-up. Multivariable logistic regression analyses were computed to identify risk factors for incontinence and gait dysmobility at 3 months after ICH. The study population consisted of 307 ICH cases in the discovery set and 1,374 cases in the replication set. In the discovery set, we found that increasing IVH volume was associated with incontinence (odds ratio [OR] 1.50; 95% confidence interval [CI] 1.10-2.06) and dysmobility (OR 1.58; 95% CI 1.17-2.15) after controlling for ICH location, initial ICH volume, age, baseline modified Rankin Scale score, sex, and admission Glasgow Coma Scale score. In the replication set, increasing IVH volume was also associated with both incontinence (OR 1.42; 95% CI 1.27-1.60) and dysmobility (OR 1.40; 95% CI 1.24-1.57) after controlling for the same variables. ICH subjects with IVH extension are at an increased risk for developing incontinence and dysmobility after controlling for factors associated with severity and disability. This finding suggests a potential target to prevent or treat long-term disability after ICH with IVH.

Effective Factors on Urinary Incontinence in Natural Menopausal Women

Results: Multiple atrophic urogenital changes were identified including vaginal dryness (42%), decreased libido (41.3%), dyspareunia (16%), vaginal itching (11.3%) and vaginal discharge and burning (10.7%). The prevalence of urinary frequency, stress urinary incontinence, nocturia and urge urinary incontinence were 33.3%, 28.7%, 22.7% and 17.3%, respectively. A multivariate logistic model found that urinary infection (OR 5.6; 95% CI: 2.6 - 11.58), cystocele (OR 1.73; 95% CI: 1.29 - 2.33) and rectocele (OR 1.47; 95% CI: 1.20 - 1.80) were potential risk factors for incontinence. A significant association was observed between marital status and vaginal atrophy, body mass index and urinary incontinence and parity type and urinary incontinence (P < 0.05 for all). Conclusions: Multiple associations existed between atrophic urogenital changes and urinary incontinence. The most significant interaction was between urinary tract infections and urinary incontinence in menopausal women, with urinary tract infections increasing the risk of incontinence by 5.6 fold. We recommend health professionals to focus on early screening of these issues and implement educational programs for women as part of standard practice.