Risk Of Stress Urinary Incontinence Research Articles

Female non-obstetric urogenital fistula repair: long-term patient-reported outcomes and a scoping literature review.

To investigate long-term and patient-reported outcomes, including sexual function, in women undergoing urogenital fistula (UGF) repair, addressing the lack of such data in Western countries, where fistulas often result from iatrogenic causes. We conducted a retrospective analysis at a tertiary referral centre (2010-2023), classifying fistulas based on World Health Organisation criteria and evaluating surgical approaches, aetiology, and characteristics. Both objective (fistula closure, reintervention rates) and subjective outcomes (validated questionnaires) were assessed. A scoping review of patient-reported outcome measures in UGF repair was also performed. The study included 50 patients: 17 (34%) underwent transvaginal and 33 (66%) transabdominal surgery. History of hysterectomy was present in 36 patients (72%). The median (interquartile range [IQR]) operating time was 130 (88-148) min. Fistula closure was achieved in 94% of cases at a median (IQR) follow-up of 50 (16-91) months and reached 100% after three redo fistula repairs. Seven patients (14%) underwent reinterventions for stress urinary incontinence after transvaginal repair (autologous fascial slings). Patient-reported outcomes showed median (IQR) scores on the International Consultation on Incontinence Questionnaire Female Lower Urinary Tract Symptoms Modules (ICIQ-FLUTS) of 5 (3-7) for filling symptoms, 1 (0-2) for voiding symptoms and 4.5 (1-9) for incontinence symptoms. The median (IQR) score on the ICIQ Female Sexual Matters Associated with Lower Urinary Tract Symptoms Module (ICIQ-FLUTSsex) was 3 (1-5). The median (IQR) ICIQ Satisfaction (ICIQ-S) outcome score and overall satisfaction with surgery item score was 22 (18.5-23.5) and 10 (8.5-10), respectively. Higher scores indicate higher symptom burden and treatment satisfaction, respectively. Our scoping review included 1784 women, revealing mixed aetiology and methodological and aetiological heterogeneity, thus complicating cross-study comparisons. Urogenital fistula repair at a specialised centre leads to excellent outcomes and high satisfaction. Patients with urethrovaginal fistulas are at increased risk of stress urinary incontinence, possibly due to the original trauma site of the fistula.

Association Between Added Sugar Intake and Urinary Incontinence in Females: A Cross-sectional Population-based Study.

Urinary incontinence (UI) is a widespread issue in women that severely impacts quality of life. The addition of sugar is associated with multiple adverse effects on health. This study examined the potential association between added sugar intake and UI. Adult females from the National Health and Nutrition Examination Survey database (2005-2018) were included in this study. The primary outcomes were the prevalence of stress urinary incontinence (SUI), urge urinary incontinence (UUI), and mixed urinary incontinence (MUI). Weighted logistic regression, stratified logistic regression, restricted cubic spline regression, and sensitivity analyses were utilized to determine whether added sugar was associated with UI after multivariate adjustment. A total of 14,927 participants met the inclusion criteria. The results revealed a heightened prevalence ofSUI, UUI, and MUI in the fourth quartile of added sugar energy percentage (OR = 1.304, 95% confidence interval [CI] = 1.105-1.539; OR = 1.464, 95% CI = 1.248-1.717; OR = 1.657, 95% CI = 1.329-2.065 respectively). The effect was more pronounced in young women and the subgroup analyses did not reveal any noteworthy interaction effects. According to the sensitivity analyses, the results for SUI and the MUI were consistent with those of the primary analyses. The excessive intake of added sugar among women may increase their risk of SUI and MUI. Our study highlights the negative effects of added sugar on female genitourinary health and highlights the need for universal access to healthy diets.

Association of diarrhea or constipation with urinary incontinence in adults: A cross-sectional analysis of the National Health and Nutrition Examination Survey.

This study aimed to investigate the association between diarrhea or constipation and urinary incontinence (UI)in adults. Data from the National Health and Nutrition Examination Survey for 2009-2010 was used to include 4686 adults aged 20 and over in the analysis. Stress urinary incontinence (SUI)and urgency urinary incontinence (UUI)were used as outcome variables, with diarrhea and constipation as exposure factors. We first compared the baseline characteristics of those with and without SUI, as well as those with and without UUI. The impact of diarrhea or constipation on SUI and UUI was assessed using multivariate logistic regression models. To ensure the stability of the results, subgroup and stratified analyses were conducted. The prevalence rates of UUI and SUI were 22.49% and 23.39%, respectively. Adjusted multivariate logistic regression analysis revealed that the risk of UUI was increased by either diarrhea (OR1.66, 95% CI 1.36-2.04) or constipation (OR1.42, 95% CI 1.11-1.83). The risk of SUI was also elevated by either diarrhea (OR1.36, 95% CI 1.11-1.67) or constipation (OR1.32, 95% CI 1.06-1.63). Subgroup analysis revealed no significant differences in the interaction tests between constipation or diarrhea and UI. This study found that both constipation and diarrhea increase the risk of UUI and SUI.

Urethral-sparing laparoscopic simple prostatectomy for the treatment of benign prostatic hyperplasia with asymptomatic urethral stricture after urethral stricture surgery

ObjectiveTo evaluate the efficacy of urethral-sparing laparoscopic simple prostatectomy (US-LSP) for the treatment of large-volume (>80 ml) benign prostatic hyperplasia (BPH) with asymptomatic urethral stricture (urethral lumen > 16 Fr) after urethral stricture surgery.MethodsWe retrospectively analyzed clinical data of 39 large-volume BPH patients with asymptomatic urethral stricture after urethral stricture surgery who underwent US-LSP from January 2016 to October 2021. Postoperative follow-ups were scheduled at 1, 3, and 6 months.ResultsAll patients affected by significant BPH-related lower urinary tract symptoms (LUTS) including 22 cases with asymptomatic anterior urethral stricture and 17 cases with asymptomatic posterior urethral stricture. Median operative time was 118 min (interquartile range [IQR]100–145). Median estimated blood loss was 224 ml (IQR: 190–255). 33 patients(84.6%) avoided continuous bladder irrigation. Postoperative complications occurred in 5 patients (12.8%), including 4 cases with Clavien-Dindo grade 1 and grade 2 and 1 case with grade 3a. During follow-up, US-LSP presented statistically significant improvements in LUTS compared to baseline (P < 0.05). A total of 25 patients had normal ejaculation preoperatively and 3 patients (12%) complained retrograde ejaculation postoperatively. Two patients (5.1%) reported stress urinary incontinence (SUI) and no patient reported aggravated urethral stricture during follow-up.ConclusionsUS-LSP was safe and effective in treating large-volume BPH with asymptomatic urethral stricture after urethral stricture surgery. Meanwhile, US-LSP could reduce the risk of SUI in patients with asymptomatic posterior urethral stricture and maintain ejaculatory function in a high percentage of patients.

Association between exposure to multiple metals and stress urinary incontinence in women: a mixture approach.

There is limited evidence linking exposure to heavy metals, especially mixed metals, to stress urinary incontinence (SUI). This study aimed to explore the relationship between multiple metals exposure and SUI in women. The data were derived from the National Health and Nutrition Examination Survey (NHANES), 2007-2020. In the study, a total of 13 metals were analyzed in blood and urine. In addition, 5155 adult women were included, of whom 2123 (41.2%) suffered from SUI. The logistic regression model and restricted cubic spline (RCS) were conducted to assess the association of single metal exposure with SUI risk. The Bayesian kernel machine regression (BKMR) and weighted quantile sum (WQS) were used to estimate the combined effect of multiple metals exposure on SUI. First, we observed that blood Pb, Hg and urinary Pb, Cd were positively related to SUI risk, whereas urinary W was inversely related by multivariate logistic regression (all p-FDR < 0.05). Additionally, a significant non-linear relationship between blood Hg and SUI risk was observed by RCS analysis. In the co-exposure models, WQS model showed that exposure to metal mixtures in blood [OR (95%CI) = 1.18 (1.06, 1.31)] and urine [OR (95%CI) = 1.18 (1.03, 1.34)] was positively associated with SUI risk, which was consistent with the results of BKMR model. A potential interaction was identified between Hg and Cd in urine. Hg and Cd were the main contributors to the combined effects. In summary, our study indicates that exposure to heavy metal mixtures may increase SUI risk in women.

Development and Validation of a Risk Prediction Model for Female Stress Urinary Incontinence in Rural Fujian, China.

With China's rapidly aging population and the rising proportion of obese people, an increase in the number of women suffering from urinary incontinence (UI) is to be expected. In order to identify high-risk groups before leakage occurs, we aimed to develop and validate a model to predict the risk of stress UI (SUI) in rural women. This study included women aged 20-70 years in rural Fujian who participated in an epidemiologic survey of female UI conducted between June and October 2022. Subsequently the data was randomly divided into training and validation sets in a ratio of 7:3. Univariate and multivariate logistic regression analyses were used to identify independent risk factors as well as to further construct a nomogram for risk prediction. Finally, concordance index (C-index), calibration curve and decision curve analysis were applied to evaluate the performance of the predictive models. A total of 5290 rural females were enrolled, of whom 771 (14.6%) had SUI. Age, body mass index (BMI), postmenopausal status, number of vaginal deliveries, vaginal delivery of large infant, constipation and family history of pelvic organ prolapse (POP) and SUI were included in the nomogram. C-index of this prediction model for the training and validation sets was 0.835 (95% confidence interval [CI] = 0.818-0.851) and 0.829 (95% CI = 0.796-0.858), respectively, and the calibration curves and decision analysis curves for both the training and validation sets showed that the model was well-calibrated and had a positive net benefit. This model accurately estimated the SUI risk of rural women in Fujian, which may serve as an effective primary screening tool for the early identification of SUI risk and provide a basis for further implementation of individualized early intervention. Moreover, the model is concise and intuitive, which makes it more operational for rural women with scarce medical resources.

Synergistic interaction between hyperlipidemia and obesity as a risk factor for stress urinary incontinence in Americans

Urinary incontinence is a common disease among middle-aged and elderly women, which not only affects the physical and mental health of patients, but also brings a great medical burden to society. Obesity is a known risk factor for urinary incontinence and is the most common secondary cause of hyperlipidemia. Most obese patients also suffer from hyperlipidemia in the clinic. However, few studies have explored the role of hyperlipidemia in women with urinary incontinence. Using data from the 2005–2018 National Health and Nutrition Examination Survey (NHANES), we aimed to evaluated the independent associations of high body mass index and hyperlipidemia with urinary incontinence in Americans by conducting a weighted multivariate logistic regression model. Additive interactions were also assessed using the relative excess risk due to interaction (RERI), attributed proportion of interaction (AP) and synergy index (S). This study demonstrated that hyperlipidemia was associated with a higher risk of stress urinary incontinence among women with obesity (OR = 1.52, 95% CI = 1.03–2.25), and there was a significant synergistic effect of hyperlipidemia and obesity on stress urinary incontinence(adjusted RERI: 3.75, 95% CI 0.30–7.20; adjusted AP: 0.67, 95% CI 0.54–0.80; adjusted S: 5.49, 95% CI 4.15–7.27). Moreover, fasting serum triglyceride lipids were the most relevant blood lipid indicator for the risk of stress urinary incontinence, especially among obese women younger than 50 years old, which contributes to the development of more refined lipid control protocols for patients with urinary incontinence in different age groups.

Elucidating the causal landscape: Mendelian randomization analysis of lifestyle and physiological factors in stress urinary incontinence.

To explore the potential causal links between obesity, type 2 diabetes (T2D), and lifestyle choices (such as smoking, alcohol and coffee consumption, and vigorous physical activity) on stress urinary incontinence (SUI), this study employs a Mendelian Randomization approach. This research aims to clarify these associations, which have been suggested but not conclusively established in prior observational studies. Genetic instruments associated with the exposures at the genome-wide significance (p < 5 × 10-8) were selected from corresponding genome-wide association studies. Summary-level data for SUI, was obtained from the UK Biobank. A two-sample MR analysis was employed to estimate causal effects, utilizing the inverse-variance weighted (IVW) method as the primary analytical approach. Complementary sensitivity analyses including MR-PRESSO, MR-Egger, and weighted median methods were performed. The horizontal pleiotropy was detected by using MR-Egger intercept and MR-PRESSO methods, and the heterogeneity was assessed using Cochran's Q statistics. Our findings demonstrate a significant causal relationship between higher body mass index (BMI) and the risk of SUI, with increased abdominal adiposity (WHRadjBMI) similarly linked to SUI. Smoking initiation is also causally associated with an elevated risk. However, our analysis did not find definitive causal connections for other factors, including T2D, alcohol consumption, coffee intake, and vigorous physical activity. These findings provide valuable insights for clinical strategies targeting SUI, suggesting a need for heightened awareness and potential intervention in individuals with higher BMI, WHR, and smoking habits. Further research is warranted to explore the complex interplay between genetic predisposition and lifestyle choices in the pathogenesis of SUI.

The Risk of Stress Urinary Incontinence After Hysterectomy for Uterine Fibroids.

We evaluated the relationship between previous hysterectomy for uterine fibroids and subsequent stress urinary incontinence (SUI). This study analyzed national health insurance data. The hysterectomy group (aged 40 to 59) comprised patients who underwent hysterectomy for uterine fibroids between January 1, 2011 and December 31, 2014, and the control group (aged 40 to 59) comprised patients who visited a medical facility for a checkup during the same time span. One-to-one propensity score matching was performed to balance confounders. SUI was defined as the need for SUI surgery accompanied by a diagnosis code for SUI. After matching, 81,373 cases (hysterectomy group) and 81,373 controls (nonhysterectomy group) were enrolled. The mean follow-up period was 7.9 years for the cases and 7.8 years for the controls. The incidence of anti-incontinence surgery was slightly but significantly higher in the cases than in the controls (2.0% vs. 1.7%, P<0.001). Compared to the control group, abdominal hysterectomy significantly increased the likelihood of anti-incontinence surgery both before (hazard ratio [HR], 1.235; 95% confidence interval [CI], 1.116-1.365) and after adjusting for confounders (HR, 1.215; 95% CI, 1.097-1.347). In contrast, laparoscopic hysterectomy, laparoscopic hysterectomy with adnexal surgery, and abdominal hysterectomy with adnexal surgery were not associated with an increased rate of anti-incontinence surgery. The significant association between abdominal hysterectomy and an elevated rate of anti-incontinence surgery persisted even after stratifying patients by age group. Prior abdominal hysterectomy without adnexal surgery was associated with an increased incidence of subsequent anti-urinary incontinence surgery.

Associations between visceral adipose index and stress urinary incontinence among US adult women: a cross-sectional study

ObjectiveVisceral adipose index (VAI) is a novel parameter for the evaluation of visceral obesity. The present study aimed to investigate the association between VAI levels and stress urinary incontinence (SUI) in a nationally representative population.Materials and methodsThe National Health and Nutrition Examination Survey (NHANES) women population aged > 20 years were analyzed from 2001 to 2018. SUI was determined by self-reported questions. VAI was calculated using physical examination data and laboratory tests. Survey-weighted logistic regression models were used to analyze the correlation between SUI and VAI.ResultsThe final analysis included 9709 women. Among them, 4032 (41.53%) were any SUI, 1130 (11.64%) were at least weekly SUI, and 506 (5.21%) were at least daily SUI. In multivariate analysis, the odds ratio (OR) for overall SUI increased slightly after full adjustment (OR 1.06, 95% CI 1.03–1.10, P = 0.001). Similar results were observed in weekly (OR 1.04, 95% CI 1.00–1.08, P = 0.0327) and daily (OR 1.04, 95% CI 1.00–1.09, P = 0.0702) SUI. The analysis of VAI categorized showed an increased OR of any, weekly, and daily SUI in the highest compared to the lowest tertile (OR 1.44, 95% CI 1.26–1.65, P < 0.0001 for trend, OR 1.38, 95% CI 1.07–1.78, P = 0.0153 for trend, OR 1.33, 95% CI 0.94–1.87, P = 0.094 for trend).ConclusionThis study revealed a significant association between SUI and VAI among US adult women. VAI is an easily applicable index for the evaluation of visceral fat dysfunction, which might be useful for the calculation of SUI risk.

Serum albumin levels and stress urinary incontinence in females: A retrospective study based on NHANES 2007–2016

BackgroundSerum albumin (sAlb) is an essential indicator of human physiological function. However, the correlation between the concentration of sAlb and stress urinary incontinence (SUI) remains poorly understood. MethodsThe sAlb was measured using the bichromatic digital endpoint method. The SUI was assessed according to information from the National Health and Nutrition Examination Survey (NHANES) questionnaire. Univariate and multivariate logistic regression analyses of the potential correlation between sAlb and stress incontinence were performed. Subgroup analysis was also conducted according to body mass index (BMI). ResultsAfter adjusting for potential key confounders, sAlb was found to have a significant association with SUI in adult females, and higher sAlb levels were associated with a lower risk of SUI (OR = 0.849; 95 % CI: 0.724–0.994; P = 0.042). Furthermore, subgroup analysis indicated that sAlb was associated with reduced SUI risk only in the subgroup with a body mass index (BMI) ≥ 30 (OR = 0.762; 95 % CI: 0.595–0.975; P = 0.030). ConclusionFemale SUI was correlated with sAlb concentration, and a lower risk of SUI was seen in those with greater sAlb levels. These findings provide new insights into SUI prevention.

Unilateral levator avulsion increases the risk of de novo stress urinary incontinence after cystocele repair.

Patients without concurrent baseline stress urinary incontinence (SUI) can develop de novo SUI after transvaginal mesh surgery (TVM) for cystocele repair. Surgeons should be aware of de novo SUI risk factors after TVM. A total of 1124 women who were underwent TVM surgeries were recruited and assessed for eligibility from January 1, 2012 to April 30, 2021. All data related to patients and surgeries was collected, which included general conditions, clinical examination, surgery records, and follow-up results. Patients were divided into three groups according to follow-up results and data were compared with each group. The relative risk (RR) of de novo SUI with levator avulsion was also calculated. Three hundred thirty-six patients were included in this study. They were divided into no complication group (n = 249), de novo SUI group (n = 68), and other complications group (n = 19). It seemed elder or obese women had a higher risk of de novo SUI after TVM (p < 0.05). In de novo SUI group, incidence of levator avulsion before surgery were higher than the other two groups (p = 0.001). TVM can significantly change a prolapse to point Aa and Ba on POP-Q quantification system (p < 0.05). RR ratios of de novo SUI with unilateral avulsion group is 2.60 (95% confidence interval [CI] 1.39-4.87), and 2.58 (95%CI 0.82-8.15) for bilateral group. Unilateral levator avulsion, instead of bilateral levator avulsion, is a risk factor of de novo SUI after cystocele repair surgery.

Association between respiratory disease and stress urinary incontinence: An analysis of the 2015-2020 National Health and Nutrition Examination Survey.

There is a logical association between chronic obstructive pulmonary disease (COPD) or asthma with stress urinary incontinence (SUI), given the propensity for coughing which increases intra-abdominal pressure. However, there are few studies examining the association between COPD or asthma and specifically SUI. We aimed to utilize the National Health and Nutrition Examination Survey (NHANES) data from 2015 to 2020 to measure the association between respiratory diseases like COPD and asthma with SUI. Data was collected from NHANES, a database representative of the United States population. Participants were included if they were female, older than 20 years, and completed the incontinence survey question. Self-reported history of asthma and COPD diagnosis from a physician, as well as history of incontinence associated with activities such as coughing, lifting, or exercise, were collected. Characteristics of participants were compared using χ2 and Student t-tests. Multivariable logistic regression was performed using a multimodel approach to adjust for sociodemographic and health-related covariates. A total of 9059 women were included in this study. 42.13% reported an episode of SUI in the past year, 6.29% had a COPD diagnosis, and 11.86% had an asthma diagnosis. In the unadjusted analysis, participants with COPD were more likely to report SUI (odds ratio [OR] 3.42, 95% confidence interval [CI] 2.13-5.49, p < 0.001); this association persisted on multivariable analysis (OR 2.87, 95% CI 1.46-5.60, p = 0.003). There was no significant association between asthma and SUI in the unadjusted (OR 1.15, 95% CI 0.96-1.38, p = 0.14) or adjusted model (OR 1.18, 95% CI 0.86-1.60, p = 0.30). Although a strong association between COPD and SUI was observed, an analogous one was not found between asthma and SUI. Chronic cough may be more difficult to control with treatment or more common in those with COPD than asthma, explaining this difference. Future research should continue to explore drivers for SUI in large populations to dispel or affirm historically assumed SUI risk factors.

Factors Associated With Stress Urinary Incontinence and Diastasis of Rectus Abdominis in Women at 6-8 Weeks Postpartum.

In recent years, pelvic-abdominal dynamics has become a research topic in the field of pelvic floor dysfunction (PFD), and the relationship between diastasis of the rectus abdominis (DRA) and stress urinary incontinence (SUI) has been controversial. The study is helpful to further strengthen perinatal education, accurately identify the risk factors of SUI and DRA, and improve the quality of life of puerperae. This study aimed to investigate the association of SUI and DRA in women with PFD as measured by vaginal palpation or pelvic floor biofeedback machine testing. A total of 301 patients diagnosed with female PFD who were 6-8 weeks postpartum at The Fifth People's Hospital of Zhuhai between May 2018 and April 2021 were enrolled. The prevalence rates and potential influencing factors of SUI and DRA were analyzed. A total of 29.5% (89 of 301) of the patients were diagnosed with SUI, and 31.9% (96 of 301) were diagnosed with DRA. Binary logistic regression showed that a history of delivery ( P = 0.012; odds ratio [OR], 1.982) and vaginal delivery with perineal lacerations or episiotomy ( P = 0.016; OR, 2.187) were risk factors for SUI. High birth weight (weight>4.0 kg, P < 0.001; OR, 14.507) was a risk factor for DRA. A history of delivery and vaginal delivery with perineal lacerations or episiotomy increased the risk of SUI, and high birth weight was an independent risk factor for DRA. Early intervention, including exercise therapy, manual therapy, and neuromuscular electrical stimulation, may be important for patients with PFD having these risk factors.

Association between vaginal or cesarean delivery and later development of stress urinary incontinence or pelvic organ prolapse: A retrospective population-based cohort study.

Child delivery mode may be associated with pelvic floor disorders. We explored the association between different delivery modes and later development of stress urinary incontinence (SUI) and pelvic organ prolapse (POP) in Taiwanese women. This was a retrospective population-based cohort study. Women who delivered babies between January 1, 2000, and December 31, 2018, were selected for this study. The study used Taiwan's National Health Insurance (NHI) Research Database. After propensity score matching, 51,587 women who underwent cesarean section (C/S) and 51,587 women who underwent vaginal delivery (VD) were recruited. Primary outcomes were the presence of SUI and POP after delivery. The incidence of SUI (1.6/1000 person-years) and POP (1.5/1000 person-years) was higher in the VD group than in the C/S group (0.8 and 0.6 in 1000 person-years). VD was associated with an increased risk of SUI [hazard ratio (HR): 2.79, 95% confidence interval (CI): 2.45-3.17] and POP (HR: 1.96, 95% CI: 1.75-2.19) compared to C/S. We also found that age (HR: 1.06, 95% CI: 1.05-1.08 in SUI, HR: 1.08, 95% CI: 1.07-1.09 in POP) and Charlson Comorbidity Index (CCI) (HR: 1.28, 95% CI: 1.12-1.46 in SUI, HR: 1.27, 95% CI: 1.13-1.43 in POP) were associated with an increased risk of SUI and POP. The cumulative incidence of SUI and POP was higher in the VD group than in the C/S group (log-rank test, P < 0.05). The current study was the largest retrospective cohort study regarding the influence of delivery mode on SUI and POP so far. VD was found to be associated with an increased risk of SUI and POP compared with C/S. Postpartum care for pelvic physical therapy should be provided particularly to women undergoing VD.

Stress Urinary Incontinence After Operations for Uterine Prolapse: A Nationwide Cohort Study.

Concomitant surgery for stress urinary incontinence (SUI) during pelvic organ prolapse (POP) operations are debated. We aimed to assess the risk of an SUI operation after a uterine prolapse operation and compare the risk after the Manchester procedure versus vaginal hysterectomy. We performed a nationwide historical cohort study including women with no history of hysterectomy undergoing the Manchester procedure (n = 6065) or vaginal hysterectomy (n = 9,767) for POP during 1998 to 2018. We excluded women with previous surgery for SUI and POP, concomitant surgery for SUI (n = 34, 0.2%), and diagnosed with gynecological cancer before or within 90 days from surgery. Women were followed up until SUI operation/death/emigration/diagnosis of gynecological cancer/December 31, 2018, whichever came first. Women undergoing the Manchester procedure were censored if they had undergone hysterectomy.We assessed the rate of SUI surgery with cumulative incidence plots. We performed Cox Regression to analyze the risk of SUI surgery, adjusting for age, calendar year, income level, concomitant surgery in anterior and posterior compartments, and diagnosis of SUI before POP operation. We found that 12.4% women with and 1.6% without SUI diagnosed before the POP surgery who underwent SUI surgery within 10 years.During follow-up (median, 8.5 years), 129 (2.1%) underwent SUI surgery after the Manchester procedure and 175 (1.8%) after vaginal hysterectomy (adjusted hazard ratio, 1.06 [0.84-1.35]). Of women diagnosed with SUI before POP operation 1 in 8 subsequently underwent SUI surgery. Few women not diagnosed with SUI subsequently underwent SUI surgery. There was no difference in risk of SUI after the Manchester procedure and vaginal hysterectomy.

Does a Kegel Exercise Program Prior to Resistance Training Reduce the Risk of Stress Urinary Incontinence?

This comparative pre-post intervention study investigated the feasibility and benefits of Kegel exercises amongst incontinent women, prior to commencing resistance training (RT), to reduce the risk of stress urinary incontinence (SUI) compared to a group of women without prior Kegel exercises (KE). Incontinence severity index (ISI) score, pelvic floor muscle strength (PFMS), and body composition (such as body mass index (BMI), fat, and muscle mass), were obtained pre and post intervention. Results demonstrated that RT reduced SUI to a significantly greater extent only if preceded by KE as was observed in the Kegel exercise plus RT group (KE + RT) over time. The improvements in total ISI in both the KE + RT and RT groups were large (d = 1.50 and d = 1.17 respectively). A two-way ANOVA indicated a statistically significant improvement in average PFMS within the KE + RT group over time and between the two groups. A positive correlation was found between the average strength of pelvic floor muscles and SUI. Participants in KE + RT group demonstrated a significant increase in muscle mass (p ≤ 0.001) and concomitant reduction in fat mass (p = 0.018). This study determined a dedicated program of KE preceding a RT program improved average pelvic floor muscle strength and was effective in reducing SUI among incontinent women.

Effect of hysterectomy on re-operation for stress urinary incontinence: 10 year follow-up

PurposeHysterectomy and mid-urethral sling (MUS) are common operations, but little is known about how hysterectomy after MUS affects the risk for stress urinary incontinence (SUI) relapse.MethodsWe included 49 women with a MUS before hysterectomy and 41 women with a MUS concomitant with hysterectomy. The controls, matched by age (± 2 years), MUS type (retropubic vs transobturator) and operation year (± 2 years), included 201 women who underwent the MUS operation without a subsequent hysterectomy. We used health care registers for follow-up of 12.4 years in median (IQR 10.9–14.7) after the MUS operation to compare the number of SUI re-operations and hospital re-visits for urinary incontinence.ResultsThe re-operation rates for SUI did not differ between the women with MUS before hysterectomy (n = 2, 4.1%), women with MUS concomitant with hysterectomy (n = 2, 4.9%) and their controls (n = 4, 4.9%, p = 0.8 and n = 6, 5.0%, p = 1.0, respectively). There were significantly fewer urinary incontinence re-visits among women who had a MUS concomitant with the hysterectomy compared to their matched controls (n = 2 and 31, 5 and 31%, p < 0.01) and to the women with a MUS prior to hysterectomy (n = 2 and 10, 5 and 20%, respectively, p = 0.03).ConclusionHysterectomy after or concomitant with MUS does not seem to increase the risk for SUI re-operation or hospital re-visits for urinary incontinence. These results can be used to counsel women considering hysterectomy after MUS operation or concomitant with MUS operation.

A Retrospective Analysis of the Effects of Second - Stage Labor Arrest on Postpartum Women’s Stress Urinary Incontinence

Background: Stress Urinary Incontinence (SUI), has been always linked to normal vaginal delivery (NVD) or operative vaginal delivery (OVD). Many women get concerned about this issue before giving birth and tend to deliver by cesarean delivery. However, the increased frequency of cesarean deliveries poses health concerns especially in the absence of solid risk factors. Methods: This is a retrospective observational cohort study conducted at Rafic Hariri University Hospital (RHUH) between 2011 and 2013. Forty primiparous women undergoing cesarean delivery were involved. They were evenly divided into 2 groups. The first involved those who underwent elective cesarean delivery and those with failure to progress. The second group involved women who underwent cesarean delivery for arrested second stage of labor. Statistical analysis was performed using the statistical program SPSS version 20. Results: The prevalence of SUI in group 1 was 25% compared to 35% in group 2. Cesarean delivery was not found to have any protective role against SUI in group 1 patients and the frequency of SUI in selective cesarean patients was nearly the same as those performing cesarean for failure to progress. However, patients undergoing cesarean for arrested second stage of labor &gt; 2hours had a significant higher frequency of SUI as compared to patients undergoing cesarean delivery for arrested second stage of labor &lt; 2hours. Conclusion: Cesarean delivery cannot be proposed to women who fear to suffer from SUI post-partum. However, it should be done if the cervix fully dilated for &gt; 2hours in order to decrease the risk of SUI

High-Impact Exercises Associated with an Increased Risk of Stress Urinary Incontinence: Systematic Review and Meta-Analysis

High-Impact Exercises Associated with an Increased Risk of Stress Urinary Incontinence: Systematic Review and Meta-Analysis