Risk Of Stress Urinary Incontinence Research Articles

Impacts of Childbirth on the Subsequent Risk of Stress Urinary Incontinence

Objectives: The aim of the current study was to investigate the role of childbirth parameters on the development of stress urinary incontinence (SUI). Methods: One hundred-one healthy women (control group) and 98 patients with SUI (study group) were included in this study between March 2008 and April 2009. Obstetric history of participants was taken and labor parameters were compared between the groups. Results: The prevalence of SUI reported in the study period was 17.2%. Gravidity and parity was significantly higher in study group (P<0.001). Vaginal delivery, Kristeller manauver, operative delivery by vacuum or forceps extraction and delivery of macrosomic fetus was found to be significant risk factors for SUI (P<0.05). Conclusions: Mode of delivery and obstetric history have significant impact on subsequent SUI. Timely cesarean section in women with obstructed labor may prevent the later occurrence of SUI.

Predicting stress urinary incontinence during pregnancy: combination of pelvic floor ultrasound parameters and clinical factors.

The aim of this study was to develop and validate a predictive tool that combines pelvic floor ultrasound parameters and clinical factors for stress urinary incontinence during pregnancy. A total of 535 women in the first or second trimester of pregnancy were included for an interview and transperineal ultrasound assessment from two hospitals. Imaging data sets were analyzed offline to assess for bladder neck vertical position, urethra angles (α, β and γ angles), hiatal area and bladder neck funneling. All significant continuous variables at univariable analysis were analyzed by receiver operating characteristics. Three multivariable logistic models were built on clinical factors, and combined with ultrasound parameters. The final predictive model with best performance and fewest variables was selected to establish a nomogram. Internal and external validation of the nomogram was performed by both discrimination represented by C-index and calibration measured by Hosmer-Lemeshow test. A decision curve analysis was conducted to determine the clinical utility of the nomogram. After excluding 14 women with invalid data, 521 women were analyzed. β angle, γ angle and hiatal area had limited predictive value for stress urinary incontinence during pregnancy, with area under curves of 0.558-0.648. The final predictive model included body mass index gain since pregnancy, constipation, previous delivery mode, β angle at rest, and bladder neck funneling. The nomogram based on the final model showed good discrimination with a C-index of 0.789 and satisfactory calibration (p=0.828), both of which were supported by external validation. Decision curve analysis showed that the nomogram was clinically useful. The nomogram incorporating both the pelvic floor ultrasound parameters and clinical factors has been validated to show good discrimination and calibration, and could be an important tool for stress urinary incontinence risk prediction at an early stage of pregnancy.

MP33-01 COST IMPACT OF ELECTIVE CESAREAN DELIVERY ON FUTURE PELVIC FLOOR DISORDERS

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Pelvic Prolapse1 Apr 2018MP33-01 COST IMPACT OF ELECTIVE CESAREAN DELIVERY ON FUTURE PELVIC FLOOR DISORDERS Devin Patel, Justin Houman, James Weinberger, Lauren Wood, Jennifer Anger, and Karyn Eilber Devin PatelDevin Patel More articles by this author , Justin HoumanJustin Houman More articles by this author , James WeinbergerJames Weinberger More articles by this author , Lauren WoodLauren Wood More articles by this author , Jennifer AngerJennifer Anger More articles by this author , and Karyn EilberKaryn Eilber More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1072AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES We sought to analyze the cost impact of Cesarean versus spontaneous vaginal delivery on two common forms of pelvic floor disorders (PFDs): stress urinary incontinence (SUI) and pelvic organ prolapse (POP). METHODS We compared average cost of delivery method to the lifetime risk and cost of PFD in women <65 years of age. In this analysis, direct costs were defined based on reimbursements. Initial cost of maternal care included those incurred at delivery and three months post-partum. Future costs of PFD included those incurred after delivery up to 65 years of age. Costs of maternal care were obtained from MarketScan® databases of reimbursement. A previously reported incremental cost of illness model was used to estimate direct (inpatient and outpatient reimbursement and prescription drugs) and indirect (disability claims and imputed wages for work absence) costs for SUI. Personal costs for SUI (supplies, laundry, dry cleaning) were assumed for one year and estimated based on previous data. The cost of POP was determined by multiplying the number of POP operations by the direct costs per surgery. Previously reported data on incidence of POP and SUI in women following Cesarean and vaginal delivery was used to calculate attributable risk. RESULTS The average estimated cost for vaginal delivery was $7,089 and for Cesarean delivery was $9,905. For SUI, the average direct cost was estimated as $5,642, the average indirect cost as $4,208 and the average personal cost as $750. The average direct cost of POP surgery was $4,658. Following Cesarean delivery, the absolute risk for SUI and POP was estimated as 7% and 5%, respectively. Following vaginal delivery, the absolute risk for SUI and POP was estimated as 13% and 14%, respectively. The average woman undergoing Cesarean delivery would undergo an immediate excess cost of $2,816. The potential savings for SUI and POP in women <65 years of age would be $636 and $419, respectively, for a total of $1,055. CONCLUSIONS Although elective Cesarean is associated with reduced incidence of PFDs, the increased immediate cost of Cesarean delivery does not offset future cost savings. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e427-e428 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Devin Patel More articles by this author Justin Houman More articles by this author James Weinberger More articles by this author Lauren Wood More articles by this author Jennifer Anger More articles by this author Karyn Eilber More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Prevalence and risk of sport types to stress urinary incontinence in sportswomen: A cross-sectional study.

The objective of our study was to investigate the prevalence and risk of developing stress urinary incontinence (SUI) in each type of high-intensity sport, and the associated impact on quality of life in sportswomen. This cross-sectional study was conducted between March and November 2016. The study included 278 sportswomen. The basic inclusion criteria were being nulliparous and engaging in high-intensity physical activity. The exclusion criteria were childbirth, surgical treatment of gynecological and urological illnesses and urinary tract infection. For evaluation were used: The International Physical Activity Questionnaire (IPAQ), The International Consultation on Incontinence Questionnaire Urinary Incontinence (ICIQ-UISF), the Overactive Bladder Questionnaire (OAB-q), the Urinary Incontinence Quality of Life Scale (I-QOL). The highest percentage of SUI was found in athletes (23.8%), followed by volleyball players (19.6%). We found that cumulative metabolic equivalent (MET) did not affect SUI, but the type of sport did. The risk of SUI was highest in volleyball sportswomen (odds ratio[OR] = 2.16,95% confidence interval[CI] = 0.96-4.89, P < 0.05) and athletes (OR = 2.56,95%CI = 0.87-7.51, P = 0.08). As assessed by the I- QOL, SUI in people who participated in fitness and athletics (e.g., basketball, volleyball and handball) had a negative impact on quality of life including behavior, psychosocial impacts and social embarrassment score. Volleyball players have a 116% chance of getting SUI compared to women who play other types of sports that were analyzed as part of this study. Healthcare professionals should inform the population of sportswomen with risk factors for SUI in order to implement preventive physiotherapy for strengthening pelvic floor muscles.

Associations Between Childbirth and Urinary Incontinence After Midurethral Sling Surgery.

To assess whether subsequent childbirths affect the outcomes of midurethral sling surgery with regard to stress urinary incontinence (SUI). In this population-based cohort study, we used the validated Swedish nationwide health care registers (the Patient Register and the Medical Birth Register) to identify women with a delivery after midurethral sling surgery (n=207, study group). From the same registers we then randomly identified a control group who had no deliveries after their midurethral sling procedure (n=521, control group). The women in the control group were matched to the women in the study group by age and year of surgery. The Urogenital Distress Inventory and the Incontinence Impact Questionnaire were sent out to the study population. Symptomatic SUI was defined as the primary outcome. Secondary outcomes included the total Urogenital Distress Inventory score, Urogenital Distress Inventory subscale scores, and Incontinence Impact Questionnaire scores. A total of 728 women were eligible for the study. The response rate was 74%; 163 in the study group (64 with vaginal delivery and 95 with cesarean delivery) and 374 women in the control group were included in the analysis. The rate of SUI (primary outcome) was 36 of 163 (22%) in the study group and 63 of 374 (17%) in the control group. In a multivariate regression analysis of the primary outcome, we found no significant difference between the groups (odds ratio [OR] 1.2, 95% CI 0.7-2.0). Vaginal childbirth after midurethral sling surgery did not increase the risk of SUI compared with cesarean delivery (22% vs 22%, OR 0.6, 95% CI 0.2-1.4). There were no significant differences in Urogenital Distress Inventory and Incontinence Impact Questionnaire scores between any of the groups. Childbirth after a midurethral sling procedure is not associated with an increased risk of patient-reported SUI, and continence status is not affected by the mode of a subsequent delivery.

Incidence of Stress Urinary Incontinence After Posterior Urethroplasty for Radiation-induced Urethral Strictures

To identify the frequency of de novo stress urinary incontinence (SUI) after posterior excision and primary anastomotic (EPA) urethroplasty in patients with radiation-induced urethral strictures (RIUS) and compare with patients with pelvic fracture urethral injuries (PFUIs). A retrospective review was conducted among patients who underwent successful posterior EPA urethroplasty between 2008 and 2016 for RIUS from prostate cancer or PFUI from blunt trauma. Only patients with an intact bladder neck on imaging were included. SUI was defined by patient-reported outcomes and daily pad use. Inclusion criteria were met by 36 patients with RIUS and 33 patients with PFUI. Among the RIUS cohort, mean follow-up was 18 months, mean stricture length was 2.5 cm, and surgical dissection extended to the prostatic urethra in 67% (n = 24). The overall frequency of de novo SUI among patients with RIUS was 33% (n = 12), of which 75% (9 of 12) had prostatic urethral involvement. Two patients with RIUS (17%, n = 12) proceeded with artificial urinary sphincter (AUS) placement, whereas the remaining 10 patients required pads. SUI after urethroplasty in patients with PFUI was less common (12%, n = 4) and the prostatic urethra was involved in only 3% (n = 1) of all patients with PFUI. One patient with PFUI underwent AUS placement, whereas the remaining 3 patients did not require pads. Among RIUS patients with an intact bladder neck, SUI impacts one-third of patients. Subsequent AUS placement is uncommon. Prostatic urethral involvement increases risk of SUI. SUI is less common among patients with PFUI, likely related to a more limited involvement of the proximal bulbomembranous urethra and lack of radiation.

The urethral closure mechanism is deteriorated after anterior colporrhaphy.

Urethral pressure reflectometry (UPR) has proven highly reproducible in women with pelvic organ prolapse. We hypothesized that urethral parameters would decrease after anterior colporrhaphy. A prospective, observational study where women with anterior vaginal wall prolapse ≥stage II were assessed before and after anterior colporrhaphy. Assessments consisted of prolapse staging according to the Pelvic Organ Prolapse Quantification system, UPR measurements at rest, during squeezing and straining (at a standardized abdominal pressure of 50 cmH2O, PO-Abd 50), standardized stress tests with 300ml saline, and answering the International Consultation on Incontinence - Urinary incontinence short form. Stress urinary incontinence (SUI) was defined as a positive stress test and a questionnaire with symptoms of SUI and a bother score>1. Sample size was 30, power was 100% and the level of significance was 5%. We analyzed data with paired t-tests or non-parametric Wilcoxon signed rank tests; p-values <0.05 were considered statistically significant. Twenty-eight women who underwent anterior colporrhaphy completed the study. PO-Abd 50 decreased 12 cmH2O after surgery (p<0.0001). Five women developed postoperative SUI and one had persistent SUI; the six women's preoperative PO-Abd 50 was lower than the rest (p<0.01). If preoperative PO-Abd 50 was ≤65 cmH2O, the positive predictive value for postoperative SUI was 50%, and if PO-Abd 50 was ≥85 cmH2O, the negative predictive value was 100%. The urethral closure mechanism deteriorates after anterior colporrhaphy. Using UPR, we can calculate a woman's risk of SUI after anterior colporrhaphy.

Behaviour of urinary incontinence in the face of sacrocolpopexy

The aim of this study was to determine whether an association exists between the performance of a sacrocolpopexy for genital prolapse and the bladder function. A case series study was performed that includes all patients who received sacrocolpopexy in a tertiary Spanish hospital. An analysis was performed to study the association of some variables and the occurrence or persistence of urinary incontinence after the surgery. Forty patients with indication of sacrocolpopexy were included. A year after sacrocolpopexy, the outcomes showed 97.3% of prolapse healing. 19.3% complained about de novo stress urinary incontinence, 33.3% recovered from it and another 66.7% remained the same. Only 10.8% asked for an anti-incontinence surgery after the sacrocolpopexy. The urethral hypermobility shows an increased risk of stress urinary incontinence after the sacrocolpopexy. Based on our results, we do not consider it necessary to perform a systematic antiincontinence procedure simultaneously with sacrocolpopexy unless a woman without urethral anti-incontinence surgical background shows a urethral hypermobility.

Urethral Closure Pressure at Stress: A Predictive Measure for the Diagnosis and Severity of Urinary Incontinence in Women.

PurposeMaintaining urinary continence at stress requires a competent urethral sphincter and good suburethral support. Sphincter competence is estimated by measuring the maximal urethral closure pressure at rest. We aimed to study the value of a new urodynamic measure, the urethral closure pressure at stress (s-UCP), in the diagnosis and severity of female stress urinary incontinence (SUI).MethodsA total of 400 women without neurological disorders were included in this observational study. SUI was diagnosed using the International Continence Society definition, and severity was assessed using a validated French questionnaire, the Mesure du Handicap Urinaire. The perineal examination consisted of rating the strength of the levator ani muscle (0–5) and an assessment of bladder neck mobility using point Aa (cm). The urodynamic parameters were maximal urethral closure pressure at rest, s-UCP, Valsalva leak point pressure (cm H2O), and pressure transmission ratio (%).ResultsOf the women, 358 (89.5%) were diagnosed with SUI. The risk of SUI significantly increased as s-UCP decreased (odds ratio [OR], 0.92; 95% confidence interval, 0.88–0.98). The discriminative value of the measure was good for the diagnosis of SUI (area under curve>0.80). s-UCP values less than or equal to 20 cm H2O had a sensitivity of 73.1% and a specificity of 93.0% for predicting SUI. The association between s-UCP and SUI severity was also significant.Conclusionss-UCP is the most discriminative measure that has been identified for the diagnosis of SUI. It is strongly inversely correlated with the severity of SUI. It appears to be a specific SUI biomarker reflecting both urethral sphincter competence and urethral support.

The Risk of Recurrent Urinary Incontinence Requiring Surgery After Suburethral Sling Removal for Mesh Complications

We sought to examine the risk of recurrent stress urinary incontinence (SUI) after suburethral sling mesh removal or excision. We conducted a retrospective cohort study of patients who were continent before removal or excision of synthetic midurethral slings; this cohort of 278 subjects was much larger than seen in previous such studies. Patients with preoperative incontinence, additional vaginal mesh placements, prior mesh revision/excision, existing SUI, and prior pelvic radiation or fistula were excluded. Only patients with follow-up detailing continence status within 1 year of mesh removal were examined. Of 278 patients, 117 (70 retropubic and 47 transobturator) midurethral sling removals met inclusion criteria. Demographic data were comparable between groups. Presenting symptoms were also similar, with similar extrusion rates. Chronic pain was the reason for mesh removal in 80% of cases. In 1 year of follow-up, 38.6% (27/70) retropubic and 34.0% (16/47) transobturator sling removals had SUI requiring an anti-incontinence procedure. Total sling mesh removal was performed in 51.4% of retropubic vaginal mesh and 51.1% of transobturator mesh cases. In this continent population with sling complications, approximately 1/3 developed significant SUI within 1 year of mesh removal requiring anti-incontinence surgery, regardless of the amount or type of mesh removed. Total mesh removal did not increase SUI risk.

What is to blame for postnatal pelvic floor dysfunction in primiparous women—Pre-pregnancy or intrapartum risk factors?

BackgroundThe aetiology of pelvic floor dysfunction (PFD) is still poorly understood. However childbearing is recognized as a major risk factor. ObjectivesTo elucidate the natural history of PFD by investigating the impact of the mode of delivery on postnatal pelvic floor dysfunction in primiparas, when PFD existing before the first pregnancy is taken into consideration. Study design4P-study (Prevalence and Predictors of Pelvic floor dysfunction in Primips) is a prospective cohort study, nested within the Screening for Pregnancy Endpoints (SCOPE) study set in a tertiary referral teaching hospital with 9000 deliveries annually. Established and proposed risk factors for urinary, fecal, prolapse and sexual dysfunction and the severity of symptoms for each of these outcomes were assessed using the Australian Pelvic Floor Questionnaire in 1482 nulliparous women, who each completed the questionnaire in early pregnancy. Of these, 1060 (72%) repeated the questionnaire 12 months postpartum.Outcomes were analyzed using multivariate ordinal logistic regression. ResultsSignificant (p<0.05) risk factors for postpartum PFD were pre-pregnancy presence of similar symptoms Odds Ratio (OR) (5.0–30.0), smoking (OR 2.2–4.6), recurrent UTI (OR 2.2–17.3), high hip circumference (OR1.4–1.6), vigorous exercising (OR 3.1–17.9), induction of labor (OR 1.5–2.3), forceps delivery (OR 1.8–8.8), and 3rd degree perineal tear (OR 2.4–2.7). Cesarean section was associated with a lower risk of stress urinary incontinence (OR 0.3–0.5). Other common pre-pregnancy significant (p<0.05) risk factors for various PFD types prior to the first pregnancy were: diagnosed depression – (OR 1.6–2.1), high BMI (OR 3.1), strenuous exercising (OR 1.3–2.2), recurrent UTI (OR 1.5–2.5) and lower educational achievement (OR 1.5–1.6). ConclusionsPre-pregnancy PFD was mainly associated with modifiable risk factors such as smoking and exercising. The main risk factor for postpartum PFD was the presence of similar symptoms prior to pregnancy, followed by anthropometric and intrapartum factors. Hip circumference seems to be a better predictor of PFD compared to BMI. When pre-pregnancy PFD was included in the analysis, Cesarean section was protective only for stress urinary incontinence, while delivery by forceps increased the risk of prolapse.

PD02-08 PREVENTATIVE CONCOMITANT SLING FOR DE-NOVO STRESS URINARY INCONTINENCE AFTER ROBOTIC SACRAL COLPOPEXY DOES NOT IMPROVE LONG TERM CONTINENCE OR SATISFACTION

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Pelvic Prolapse I1 Apr 2017PD02-08 PREVENTATIVE CONCOMITANT SLING FOR DE-NOVO STRESS URINARY INCONTINENCE AFTER ROBOTIC SACRAL COLPOPEXY DOES NOT IMPROVE LONG TERM CONTINENCE OR SATISFACTION Charles Powell, Bridget Eckrich, Jeffrey Rothenberg, and Thomas Gardner Charles PowellCharles Powell More articles by this author , Bridget EckrichBridget Eckrich More articles by this author , Jeffrey RothenbergJeffrey Rothenberg More articles by this author , and Thomas GardnerThomas Gardner More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.201AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES There is a 44% risk of stress urinary incontinence (SUI) following sacral colpopexy and some advocate a concomitant sling to prevent this. Robotic Sacral Colpopexy (RSC) may carry a different risk of de-novo SUI and women may be just as satisfied with a delayed mid-urethral sling (MUS). This would reduce unnecessary MUS. We sought to determine this risk and evaluate the hypothesis that delayed MUS following RSC will have similar long term pad use, Quality of Life (QoL), Distress (UDI-6), and Impact scores (IIQ-7) compared to concomitant MUS. METHODS Retrospective review was undertaken and subjects were grouped based on continence status at the time of RSC. Incontinence was defined by self-report at any follow up visit, SUI on the supine stress test, or decision for MUS. RESULTS A retrospective review of the Indiana University RSC database between 2009 and 2015 identified 135 women who underwent RSC. 79 had no preoperative SUI and 29/79 (36.7%) of patients had at least one episode of de-novo SUI following RSC over a follow up of 17.9 months. 98 patients were evaluable post-operatively. 47/57 (82%) initially dry patients elected no concomitant MUS, and ultimately 5/47 (11%) of those chose a delayed sling at an average follow up time of 23.9 months. 10/57 (18%) preoperatively dry women elected to undergo a concomitant MUS at the time of RSC. Those undergoing delayed sling reported similar post-operative pad use, UDI-6, QoL, and IIQ-7 scores (Table 1) compared with those not undergoing a sling, suggesting that a delayed sling did not have a negative impact on QoL. Those choosing to undergo concomitant MUS reported more pads per day preoperatively (2.6 vs. 0.4) including pad use from urge incontinence. With regard to satisfaction the patients who were dry pre-operatively and chose no sling scored better (2.25 vs. 6.2, p<0.01) on the IIQ-7 compared with those choosing a concomitant sling. CONCLUSIONS Patients undergoing RSC without concomitant MUS have similar de-novo SUI rates to those undergoing open colpopexy. There appears to be no advantage to concomitant MUS at the time of RSC for women exhibiting no preoperative SUI. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e53-e54 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Charles Powell More articles by this author Bridget Eckrich More articles by this author Jeffrey Rothenberg More articles by this author Thomas Gardner More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

PD29-04 INCIDENCE OF STRESS INCONTINENCE FOLLOWING POSTERIOR URETHROPLASTY AMONG RADIATION-INDUCED POSTERIOR URETHRAL STENOSES

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Urethral Reconstruction (including Stricture, Diverticulum) II1 Apr 2017PD29-04 INCIDENCE OF STRESS INCONTINENCE FOLLOWING POSTERIOR URETHROPLASTY AMONG RADIATION-INDUCED POSTERIOR URETHRAL STENOSES Paul H Chung, Paige Esposito, Hunter Wessells, and Bryan B Voelzke Paul H ChungPaul H Chung More articles by this author , Paige EspositoPaige Esposito More articles by this author , Hunter WessellsHunter Wessells More articles by this author , and Bryan B VoelzkeBryan B Voelzke More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1356AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES No data exists regarding the frequency of de novo stress urinary incontinence (SUI) in patients with an intact bladder neck who undergo excision and primary anastomotic (EPA) urethroplasty for radiation-induced urethral stenoses (RIUS). We identified the risk for SUI in RIUS patients with urethral stenoses between the membranous and mid-prostatic urethra. A secondary aim was to compare the incidence of SIU to patients with pelvic fracture urethral injuries (PFUI) following EPA urethroplasty. METHODS Patients who underwent successful EPA urethroplasty between 2008-2016 were reviewed. Only patients with a history of RIUS from prostate cancer or PFUI from blunt trauma were included. Patients at risk for developing SUI were excluded: open bladder neck on pre-operative fluoroscopy, bladder neck dissection during urethroplasty, prior bladder neck surgery (robotic, open, or endoscopic prostate surgery), urinary tract fistula, failed prior posterior urethroplasty, or SUI at baseline. SUI was defined by patient reported outcome measures and subjective complaints. Cystoscopy was performed to assess for anatomic success of urethroplasty. RESULTS Of the total 135 patients, 47% (36/77) of RIUS and 57% (33/58) of PFUI met the inclusion criteria. Among the RIUS cohort, mean follow up was 18 months and mean stricture length was 2.5 cm. Radiated urethral strictures involved the prostatic urethra in 67% (24/36), and surgical scar excision beyond the prostate apex was necessary in 56% (20/36). The overall incidence of de novo SUI among RIUS patients was 33% (12/36). Among those with de novo SUI, 75% (9/12) had prostatic urethral involvement and 50% (6/12) required dissection beyond the prostate apex. For RIUS patients, 2/12 (17%) underwent artificial urinary sphincter (AUS) placement while the remaining 10 patients reported a mean use of 2.3 pads per day (range 1-4). SUI following urethroplasty in PFUI patients was less common (12%, 4/33). One PFUI patient underwent AUS placement while the remaining 3 patients did not report use of pads. CONCLUSIONS Among RIUS patients with an intact bladder neck, SUI is common following excision of scar in the prostatic urethra, affecting a third of the patients. SUI is less common among PFUI patients, likely related to more a reliable stricture location at the bulbomembranous urethra. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e573 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Paul H Chung More articles by this author Paige Esposito More articles by this author Hunter Wessells More articles by this author Bryan B Voelzke More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Effect of a New Risk Calculator on Patient Satisfaction With the Decision for Concomitant Midurethral Sling During Prolapse Surgery: A Randomized Controlled Trial.

To determine whether use of a new personalized risk calculator increases patient satisfaction with the decision whether or not to have a prophylactic midurethral sling (MUS) during pelvic organ prolapse (POP) surgery. We performed a randomized controlled trial involving English-speaking women without symptoms of stress urinary incontinence (SUI) with ≥ stage 2 POP who planned to undergo POP surgery with 1 of 4 fellowship-trained urogynecologists at a single academic center. Women with a history of prior POP or incontinence surgery, or who were pregnant, or unable to complete study forms were excluded. Participants were randomly assigned to standard preoperative counseling or preoperative counseling with the use of a validated, online risk calculator for de novo SUI after POP surgery. The primary outcome was patient satisfaction with the decision for prophylactic MUS placement during POP surgery at 3 months postoperative assessed using the Satisfaction with Decision Scale for Pelvic Floor Disorders. Sixty-three women were approached for participation. Forty-two agreed to participate, 41 underwent randomization, and 33 had POP surgery and completed 3-month follow-up. Of these 33, 17 were randomized to the risk calculator and 16 to standard counseling. The mean age was 61.2 ± 9.1 years, and 41% (14/33) had a prophylactic MUS. At 3 months postoperative, there was no difference in Satisfaction with Decision Scale for Pelvic Floor Disorders scores between groups (4.67 ± 0.46 [intervention] vs 4.78 ± 0.34 [control]; P = 0.61). Use of the de novo SUI risk calculator did not increase patient satisfaction with the decision regarding MUS placement during POP surgery.

Urinary Incontinence in Older Women: The Role of Body Composition and Muscle Strength: From the Health, Aging, and Body Composition Study.

To evaluate prospective relationships between body composition and muscle strength with predominantly stress urinary incontinence (SUI) and urgency urinary incontinence (UUI) in older women. Prospective community-dwelling observational cohort study (Health, Aging, and Body Composition study). Women initially aged 70 to 79 recruited from Pittsburgh, Pennsylvania, and Memphis, Tennessee (N = 1,475). Urinary incontinence was assessed using structured questionnaires. Body mass index (BMI), grip strength, quadriceps torque, and walking speed were assessed using physical examination and performance testing. Appendicular lean body mass (ALM) and whole-body fat mass were measured using dual-energy X-ray absorptiometry. At baseline, 212 (14%) women reported at least monthly predominantly SUI and 233 (16%) at least monthly predominantly UUI. At 3 years, of 1,137 women, 164 (14%) had new or persistent SUI, and 320 (28%) had new or persistent UUI. Women had greater odds of new or persistent SUI if they demonstrated a 5% or greater decrease in grip strength, (adjusted odds ratio (AOR) = 1.60, P = .047) and lower odds of new or persistent SUI if they demonstrated a 5% or greater decrease in BMI (AOR = 0.46, P = .01), a 5% or greater increase in ALM corrected for BMI (AOR = 0.17, P = .004), or a 5% or greater decrease in fat mass (AOR = 0.53, P = .01). Only a 5% or greater increase in walking speed was associated with new or persistent UUI over 3 years (AOR = 1.54, P = .04). In women aged 70 and older, changes in body composition and grip strength were associated with changes in SUI frequency over time. In contrast, changes in these factors did not influence UUI. Findings suggest that optimization of body composition and muscle strength is more likely to modify risk of SUI than of UUI in older women.

Prevalence and risk factors of persistent stress urinary incontinence at three months postpartum in Indonesian women

Background: Mode of delivery and some certain risk factors have a relationship to postpartum stress urinary incontinence (SUI). For that reason, the objective of this study was to assess the prevalence of postpartum stress urinary incontinence (SUI), the relationship between postpartum SUI and mode of delivery; and the association between SUI and other demographic and obstetric factors.Methods: In this prospective observational cohort study, all primiparous women who were under postpartum care in obstetric and gynecologic ward were recruited. Four hundreds primiparous women with no history of urinary incontinence (UI) who fulfilled the criteria and would like to participate in this study were followed up for three months after delivery. The analysis was done using Stata 12. Bivariate analysis using Chi-square test and multivariate analysis using logistic regression test were done to obtain associated risk factors to postpartum SUI.Results: The prevalence of postpartum SUI was 8.8%. The mode of delivery was significantly associated with postpartum SUI, there were more women who got vaginal delivery that had stress urinary incontinence (14.1%) compared to women caesarean section (7.1%) with OR=2.1 (95% CI=1.05-4.31), this risk increased when vaginal delivery was assisted with vacuum instrument (OR=9.1, 95% CI=3.9-21.6). There was no statistical difference of stress urinary incontinence incidences in patients with emergency or elective caesarean section with OR=0.84 (95% CI=0.28-2.57). Based on multivariate analysis BMI ≥30 kg/m2 at labor, vacuum assisted delivery, birth weight more than 3,360 g, and second stage labor more than 60 minutes appeared to be associated with an increased rate of postpartum SUI.Conclusion: Stress urinary incontinence increased in the early postpartum period of a primiparous woman. Although vaginal delivery increased the risk of postpartum SUI, elective nor emergency caesarean delivery without vaginal delivery id not appear to increase the risk of stress urinary incontinence.

PD25-01 LONG-TERM IMPACT OF MODE OF DELIVERY ON STRESS URINARY INCONTINENCE AND URGENCY URINARY INCONTINENCE: A SYSTEMATIC REVIEW AND META-ANALYSIS.

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Value of Care: Cost and Outcomes Measures I1 Apr 2016PD25-01 LONG-TERM IMPACT OF MODE OF DELIVERY ON STRESS URINARY INCONTINENCE AND URGENCY URINARY INCONTINENCE: A SYSTEMATIC REVIEW AND META-ANALYSIS. Riikka Tähtinen, Rufus Cartwright, Johnson Tsui, Riikka Aaltonen, Yoshitaka Aoki, Jovita Cárdenas, Regina El Dib, Kirsi Joronen, Sumayyah Al Juaid, Sabreen Kalantan, Michal Kochana, Malgorzata Kopec, Luciane Lopes, Enaya Mirza, Sanna Oksjoki, Jori Pesonen, Antti Valpas, Li Wang, Yuqing Zhang, Diane Heels-Ansdell, Gordon Guyatt, and Kari Tikkinen Riikka TähtinenRiikka Tähtinen More articles by this author , Rufus CartwrightRufus Cartwright More articles by this author , Johnson TsuiJohnson Tsui More articles by this author , Riikka AaltonenRiikka Aaltonen More articles by this author , Yoshitaka AokiYoshitaka Aoki More articles by this author , Jovita CárdenasJovita Cárdenas More articles by this author , Regina El DibRegina El Dib More articles by this author , Kirsi JoronenKirsi Joronen More articles by this author , Sumayyah Al JuaidSumayyah Al Juaid More articles by this author , Sabreen KalantanSabreen Kalantan More articles by this author , Michal KochanaMichal Kochana More articles by this author , Malgorzata KopecMalgorzata Kopec More articles by this author , Luciane LopesLuciane Lopes More articles by this author , Enaya MirzaEnaya Mirza More articles by this author , Sanna OksjokiSanna Oksjoki More articles by this author , Jori PesonenJori Pesonen More articles by this author , Antti ValpasAntti Valpas More articles by this author , Li WangLi Wang More articles by this author , Yuqing ZhangYuqing Zhang More articles by this author , Diane Heels-AnsdellDiane Heels-Ansdell More articles by this author , Gordon GuyattGordon Guyatt More articles by this author , and Kari TikkinenKari Tikkinen More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.231AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Stress urinary incontinence (SUI) and urgency urinary incontinence (UUI) are associated with physical and psychological morbidity, and large social costs. The long-term effects of delivery modes on each kind of incontinence remain uncertain. We performed a systematic review and meta-analysis to investigate the long-term impact of mode of delivery on SUI and UUI. METHODS We searched MEDLINE, Scopus, and CINAHL, and abstracts from relevant major conferences, up to October 2014. Any randomized trial or observational study with adjusted analyses, comparing estimates for the impact of two delivery modes on the risk of SUI or UUI more than 1-year post delivery were eligible. Two reviewers extracted data, including incidence/prevalence of SUI and UUI by delivery modes, and assessed risk of bias. Outcomes were categorized in accordance with ICS/IUGA definitions, and we followed PRISMA reporting guidance. RESULTS Our search yielded 3,487 potentially relevant reports of which 16 studies for SUI, and 8 studies for UUI proved eligible. Pooled estimates from 15 eligible studies demonstrated an increased risk of SUI after vaginal delivery versus cesarean section (adjusted odds ratio, aOR; 1.85, 95%CI 1.56-2.19; I2=57%), risk difference 8.2% (Fig 1). A meta-regression demonstrated a stronger association with vaginal delivery in younger women (P=0.005). Four studies suggested no difference in the risk of SUI between spontaneous vaginal and instrumental delivery (aOR 1.11, 95%CI 0.84-1.45; I2=50%). Eight studies suggested an elevated risk of UUI after vaginal delivery versus cesarean section (aOR 1.30 95%CI 1.02-1.65; I2=37%), risk difference 2.6%. Figure 1. Forest plot, risk of stress urinary incontinence between vaginal delivery and cesarean section CONCLUSIONS Vaginal delivery is associated with an almost twofold increase in the risk of long-term SUI, an absolute increase of 8%, when compared to cesarean section. The gradient of risk is larger in younger and smaller in older women. There is also an increased risk of UUI, with an absolute increase of approximately 3%. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e587 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Riikka Tähtinen More articles by this author Rufus Cartwright More articles by this author Johnson Tsui More articles by this author Riikka Aaltonen More articles by this author Yoshitaka Aoki More articles by this author Jovita Cárdenas More articles by this author Regina El Dib More articles by this author Kirsi Joronen More articles by this author Sumayyah Al Juaid More articles by this author Sabreen Kalantan More articles by this author Michal Kochana More articles by this author Malgorzata Kopec More articles by this author Luciane Lopes More articles by this author Enaya Mirza More articles by this author Sanna Oksjoki More articles by this author Jori Pesonen More articles by this author Antti Valpas More articles by this author Li Wang More articles by this author Yuqing Zhang More articles by this author Diane Heels-Ansdell More articles by this author Gordon Guyatt More articles by this author Kari Tikkinen More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Stress urinary incontinence is highly prevalent in recreationally active women attending gyms or exercise classes

The purpose of this study was to determine the prevalence of stress urinary incontinence (SUI) in recreationally active women attending gyms or exercise classes. Data were collected on the frequency and severity of incontinence and the prevalence of SUI risk factors; screening for PFM dysfunction in a fitness appraisal; symptom modification strategies; knowledge of pelvic floor muscle (PFM) exercises and the Pelvic Floor First (PFF) initiative. Three hundred and sixty-one women aged 18-83 who attended exercise classes or gyms in Western Australia were surveyed. Nearly half (49.3%) of participants reported SUI, the majority of whom slight or moderate leakage. Ninety-six per cent reported at least one SUI risk factor, with the mean being 2.7 (SD = 1.4). Almost all women surveyed had heard of PFM exercises (97.2%), but only 15.2% of participants were screened for PFM dysfunction in a fitness appraisal. Forty-three per cent reported that a fitness instructor cued PFM activation during a workout. Less than 1 in 10 (9.7%) of the women surveyed had heard about the PFF initiative. Urinary incontinence is common in women attending gyms or exercise classes, but is rarely screened for. More education is required to encourage fitness leaders to screen exercise participants and to provide PFM-'friendly" modifications.

Primary treatment of female urethral stricture by nurses leads to improved outcomes

ABSTRACTFemale urethral stricture (FUS) is a distressing disease in the field of urology both for the patient and for the health care provider. It has been treated using various techniques such as urethral dilatation (UD), urethrotomy and urethroplasty. The disease's recurrence after urethral dilation, however, is not uncommon. Female urethroplasty carries the risk of stress urinary incontinence, and long‐term studies on its success are lacking. We present our study of treating FUS by repeated UD in a dedicated cystoscopy and dilation clinic managed by nurses. After the initial cystoscopy and dilation of FUS to 30 Fr, patients were followed up with in the dilation clinic at regular intervals. Over the past 5 years, 190 patients have been treated at our cystoscopy and dilation clinic and at are various stages of follow up. We find that the primary treatment of FUS by nurses at our institute leads to improved outcomes. Nurse‐led cystoscopies have been in vogue in Australia and the UK for some time now. There is an urgent need to expand the conventional indications of nurse‐led surgical interventions in order to allow medical care to reach the community at large.

Should Prophylactic Anti-Incontinence Procedures Be Performed at the Time of Prolapse Repair? Systematic Review

Urodynamic studies performed prior to prolapse repair in women with high-grade pelvic organ prolapse (POP) have revealed asymptomatic stress urinary incontinence (SUI) in 36% to 80% of these women. The probable explanation for maintenance of continence prior to surgery in these patients may be urethral kinking or compression of the urethra by the genital prolapse. Once the genital prolapse has been repaired, these women are at high risk of postoperative SUI. Although occult SUI and prolapse repair can be corrected during a single surgery, combining both procedures is highly controversial. Some surgeons question the effectiveness of a single surgery to make both repairs and recommend a second surgical procedure after prolapse repair to correct occult incontinence. However, there are risks associated with a new hospitalization and a second surgery. This systematic literature review was conducted to determine whether performing prophylactic anti-incontinence procedures during surgical POP correction in women with severe genital prolapse and no symptoms of incontinence could prevent postoperative SUI. PubMed, EMBASE, Cochrane Library, and Lilacs databases were searched to identify articles published up to January 12, 2014. The search was limited to randomized trials. All participants had severe POP and no symptoms of SUI prior to prolapse surgery. The primary study outcome was the incidence of SUI or the need of treatment for this condition after the surgical procedure. The initial search identified 5618 studies; 66% of these were selected for full text analysis. Only 7 of these trials met the study inclusion and exclusion criteria. Following the systematic review, a meta-analysis was performed with common variables of studies and the same scale of quantification. Performance of any prophylactic anti-incontinence procedure during prolapse repair reduced the incidence of SUI postoperatively; the relative risk was 0.51, with a 95% confidence interval of 0.38 to 0.68. However, the results were different when the types of anti-incontinence procedure used were analyzed separately. The only anti-incontinence procedure that led to a significant reduction in the incidence of UI was retropubic midurethral sling surgery (relative risk, 0.09; 95% confidence interval, 0.02–0.36). These data show that use of the retropubic midurethral sling concomitantly with prolapse repair in women with severe POP is the only prophylactic anti-incontinence procedure that reduces risk of SUI.