Risk Of Urinary Incontinence Research Articles

The impact of appendicular skeletal muscle index and trunk muscle index on stress urinary incontinence risk in female adults: a retrospective study

ObjectiveThis study sought to examine the effect of the appendicular skeletal muscle index (ASMI) and trunk muscle index (TMI) on the likelihood of stress urinary incontinence (SUI) among female adults.MethodsThis investigation utilized data from the National Health and Nutrition Examination Survey from 2001 to 2006 and 2011–2018. To evaluate the impact of ASMI and TMI on the likelihood of SUI, the study utilized restricted cubic splines (RCS) and weighted multivariable logistic regression models. Subgroup and interaction analyses were conducted to investigate how other covariates influenced their relationship.ResultsIn total, 11,168 female adults participated in the analysis. Multivariable logistic regression analysis revealed that high TMI was associated with a decreased likelihood of SUI (OR = 0.34; 95% CI: 0.16–0.75; p = 0.013). ASMI was not correlated with the likelihood of SUI. RCS analysis demonstrated a linear correlation between TMI and SUI risk, showing a decreasing trend in SUI risk as TMI increases (p for overall <0.001, p for nonlinearity = 0.73).ConclusionOur study results showed that there was no association between ASMI and the risk of SUI, while a high TMI reduced the risk of SUI. This suggested that the ratio of muscle mass and BMI in different body regions has varying effects on SUI.

The Association Between Blood Lead Levels and Urgency Urinary Incontinence Among Adult Females: A Retrospective Study Based on NHANES 2005-2020.

The purpose of this study is to investigate whether blood lead levels influence the risk of urgency urinary incontinence (UUI) in adult females. This study utilized data from the National Health and Nutrition Examination Survey from 2005 to 2020, involving 9509 adult women aged 20 and older. The effect of blood lead levels on UUI was assessed using weighted multivariate logistic regression models. Additionally, the relationship between the two was illustrated using restricted cubic splines. Stratified analyses based on covariate categories were used to explore if factors influenced the relationship between blood lead levels and UUI. Adjusted multivariate logistic regression analysis indicated that for each unit increase in blood lead levels, the risk of UUI increased by 10% (OR = 1.10; 95% CI, 1.02-1.17; P = 0.01). After categorizing blood lead levels into weighted tertiles, compared to the first tertile, the third tertile increased the risk of UUI by 1.34 times in Model 1 (OR = 1.34; 95% CI, 1.13-1.59; P < 0.001). A restricted cubic spline analysis demonstrated a nonlinear relationship between blood lead levels and UUI (P for nonlinearity = 0.016). Stratified analysis revealed that baseline characteristics such as age, BMI, and PIR did not have an impact on the association between blood lead levels and UUI. This study demonstrated a close association between the risk of blood lead levels and UUI in adult women aged 20 and above. High blood lead levels were found to increase the risk of UUI.

Risk factors for developing residual stress urinary incontinence after vesico-vaginal fistula repair: A retrospective cohort study

BackgroundPrevious studies have identified predictors for residual urinary incontinence after successful closure of fistula. However, these findings remain uncertain because the predictors vary from one study to another. The present study aimed to examine the risk of residual stress urinary incontinence after successful closure of vesico-vaginal fistula (VVF). Materials and methodsWe conducted a multicenter retrospective cohort study over 07-years period, from 1st January, 2010 to 31 December, 2016. We included women who underwent VVF repair in one of the seven fistula centers. At three months postoperatively, a cough test was performed among patients who had their fistula successfully closed. The predicted outcome was the urinary continence status after sussessful closure of the fistula and was categorized as (Residual stress urinary incontinence and No Residual stress urinary incontinence). Multivariable binary logistic regression model was performed to analyze association between outcome and predictors. ResultsOverall fistula closure rate at 3 months was 88.6% (404/456). Of the patients who had their fistula successfully closed, 16.3% (66/404) experienced a residual stress urinary incontinence. Risk factors for residual stress urinary incontinence in univariate analysis were: urethro-vesical junction involvement, circumferential fistula, Goh type 3, fistula size greater than 3cm, previous fistula repair, urethra involvement. Three independent predictors have been identified: urethro-vesical junction involvement, previous fistula repair and type 3 of Goh's classification. ConclusionThis study showed that the rate of residual stress urinary incontinence is high in our setting. The involvement of sphincteric mechanism is the main predictor.

Associations of sarcopenia, obesity, and metabolic health with the risk of urinary incontinence in U.S. adult women: a population-based cross-sectional study.

Urinary incontinence (UI) significantly impairs women's quality of life. Identifying its risk factors is essential for developing effective interventions. Sarcopenia, characterized by the accelerated loss of muscle mass and function, is an emerging concern often linked to obesity and abnormal metabolic status, exacerbating various adverse health outcomes. This population-based study aimed to explore the independent and joint associations of sarcopenia, obesity, and metabolic health with UI risk, as well as to evaluate the mediating role of metabolic indicators in these associations. A total of 3,557 women aged ≥20 years from the National Health and Nutrition Examination Survey were included. Sarcopenia was assessed using the appendicular lean mass index (ALMI), and obesity was defined by body mass index and waist circumference. Metabolic health was evaluated using revised criteria from the National Cholesterol Education Program-Adult Treatment Panel III. UI was identified through responses to the "Kidney Conditions-Urology" questionnaire and classified into stress UI (SUI), urgency UI (UUI), and mixed UI (MUI). Multivariable logistic regression and restricted cubic spline models were used to evaluate the associations and visualize the relationship between ALMI and UI. Mediation models were constructed to assess the mediating role of metabolic indicators. We found that sarcopenia was significantly associated with an increased risk of MUI in the general population. Age-specific analysis revealed that sarcopenia is an independent risk factor for SUI in women aged ≥60, and for MUI in women aged 40-59 years. Sarcopenic obesity, particularly under central obesity criteria, further elevated the risk of UI. Notably, women with the metabolically unhealthy obese phenotype with sarcopenia were at the highest risk for both SUI and MUI. Metabolically unhealthy status, glycohemoglobin, vitamin D, and serum albumin levels were partial mediators of these associations. Our findings elucidated the complex interactions between sarcopenia, obesity, and metabolic health, underscoring the critical need for integrated therapeutic strategies that address both metabolic health and targeted nutritional interventions, aiming to enhance muscular health and effectively manage and prevent UI.

12565 Expression Of Sex Hormone Receptors In Levator Ani Muscle Tissue From Patients With Pelvic Organ Prolapse

Abstract Disclosure: T. You: None. A. Halle: None. W. Xu: None. T. Potluri: None. H. Nguyen: None. S.E. Bulun: None. J. Julia Geynisman-Tan: None. H. Zhao: None. Introduction: Women with pelvic floor disorders usually have weakened pelvic floor muscles, which may cause urinary incontinence, fecal incontinence, and pelvic organ prolapse (POP). Histologically, the pelvic floor musculature in POP patients displays increased fibrosis and muscle atrophy. However, the underlying molecular mechanism for POP has not been fully investigated. We and others found that estrogen causes pelvic skeletal muscle fibrosis and inguinal hernias in male animal models. Additionally, clinical trials from the Women's Health Initiative showed women receiving estrogen-only or estrogen plus progestin treatment had statistically significant increases in the risk for urinary incontinence. However, the role of estrogen, progesterone, androgen, and their receptor expression in pelvic floor muscle is not well studied. Methods: TruCut biopsy needles were used to obtain levator ani (LA, the major pelvic floor muscle) biopsies from four groups of patients undergoing surgery: (i) 5 premenopausal women with stage II/III POP (age 38-52 years), (ii) 5 postmenopausal women with stage III POP (59-75 years), (iii) 5 age and parity matched premenopausal controls, and (iv) 5 age and parity matched postmenopausal controls. The control patients did not have any POP (stage 0) or only had sole stress urinary incontinence. H&amp;E staining, Masson’s trichrome staining, and immunohistochemistry (IHC) staining for estrogen receptor α (ERα), progesterone receptor (PGR), and androgen receptor (AR) were performed in LA muscle tissue. Standard patient demographics (age, parity, and diagnosis) were collected. Results: We used H&amp;E staining to morphologically assess stromal cells and myofibers obtained from LA muscle biopsies. Masson’s trichrome staining showed extracellular matrix deposition in the LA muscle from women with or without POP. In addition, we found ERα was present in the stromal cells from nearly every LA biopsy using IHC staining. ERα expression (H-Score) was similar in four groups of patients. ERα IHC staining was absent in LA myofibers. AR was highly expressed in stromal cells in all LA muscles and weakly expressed in myofibers in ∼70% of LA tissues. AR expression (H-Score) was significantly decreased in postmenopausal women with stage III pelvic organ prolapse. PGR was only expressed in a small portion of the LA sample (30%), with PGR exclusively expressed in the stroma of the LA muscle. Conclusion: Our findings indicate that sex hormone receptors (ERα, AR, and PGR) are present in LA muscle stroma, providing the foundation to further define the roles of sex steroid hormones in pelvic organ prolapse. Presentation: 6/3/2024

232 - Hysterectomy is not associated with increased risk of urinary incontinence - A Northern Finland Birth Cohort 1966 study

232 - Hysterectomy is not associated with increased risk of urinary incontinence - A Northern Finland Birth Cohort 1966 study

Incidence, Prevalence, and Risk for Urinary Incontinence for People with Dementia in the Community in Aotearoa New Zealand: An interRAI Study

ObjectivesTo identify 1-year period prevalence, 5-year incidence rate, and risks for urinary incontinence (UI) for people living with dementia. DesignRetrospective cohort study. Setting and ParticipantsParticipants completed an International Residential Assessment Instrument Home Care (interRAI-HC) assessment in a 5-year period between August 1, 2016 and July 31, 2021 in Aotearoa New Zealand (N = 109,964). MethodsFor prevalence analysis, a dementia cohort was selected for a 1-year period from August 1, 2020 to July 31, 2021 (n = 7775). For incidence analysis, participants in the dementia cohort were followed from the first dementia diagnosis during the 5-year period. Dementia was identified by combining diagnoses of “Alzheimer's disease” and “Dementia other than Alzheimer's disease.” Participants were coded with UI if they were infrequently, occasionally, or frequently incontinent or if continence was managed with catheter/ostomy. Univariate and multivariate logistic regression analyses identified risk factors predicting UI onset. Cox regression analysis compared survival curves (months without UI) of the dementia and non-dementia cohorts, adjusting for variables significantly associated with incident UI in either cohort. ResultsThe 1-year period (August 1, 2020 to July 31, 2021) prevalence of UI was 50.1% among people with dementia. The 5-year incident UI rate was 30.2 per 100 person-years for the dementia cohort and 24.5 per 100 person-years for the non-dementia cohort. Parkinson's disease posed the greatest risk of UI in both cohorts [dementia cohort odds ratio (OR), 3.0; 95% CI, 2.1–4.2; non-dementia cohort OR, 1.7; 95% CI, 1.4–2.0]. Controlling for risk factors, the hazard ratio for UI was 1.4 for people with dementia. Conclusions and ImplicationsUI affects a significant proportion of people with dementia in Aotearoa New Zealand. Health professionals should directly ask about UI and consider living arrangements and comorbidities for people with dementia. Data-driven insights from interRAI-HC can guide resource allocation and service planning.

Correlation Between Metabolic Dysfunction-Associated Steatotic Liver Disease and the Risk of Urinary Incontinence in Adult Women.

This study examined the relationship between metabolic dysfunction-associated steatotic liver disease (MASLD) and urinary incontinence in adult women and evaluated the potential contribution of the fatty liver index (FLI) in this context. The study utilized data from the National Health and Nutrition Examination Survey (NHANES) database, spanning from 2001 to 2018. The study included 17,221 adult female participants. Individuals exhibiting FLI values of 60 or greater were diagnosed with hepatic steatosis. Incontinence type and MASLD status were evaluated by analyzing questionnaire data and calculating the FLI. Logistic regression models were employed to examine the correlation between FLI, MASLD, and urinary incontinence, with potential confounding variables controlled through multivariate adjustment models. Furthermore, restricted cubic spline curve (RCS) modeling and subgroup analysis were employed to elucidate the relationship between variables further. The median age of participants in the MASLD group was higher than that of the non-MASLD group (53 vs 46 years, P < 0.001). The findings indicated a positive association between FLI and MASLD and the risk of urinary incontinence. Specifically, the risk of stress urinary incontinence (SUI), urgency urinary incontinence (UUI), and mixed urinary incontinence (MUI) all increased significantly with increasing quartiles of FLI (OR 2.44, 1.91, 2.30, respectively, P < 0.001). In the multivariate-adjusted model, SUI, UUI, and MUI risk was 76%, 50%, and 69% higher in patients with MASLD than those without MASLD. RCS analysis demonstrated a significant nonlinear positive correlation between FLI and the risk of SUI, UUI, and MUI, respectively. This study's findings indicate a significant association between MASLD and the risk of developing urinary incontinence. Additionally, the results suggest that FLI and MASLD may act as independent risk factors for urinary incontinence.

Pelvic Floor Symptoms 4 Years After Elective Labor Induction: A Randomized Clinical Trial.

Pelvic floor disorders are common and burdensome. Data on the effect of induction of labor on pelvic floor disorders are sparse and results are mixed. Our aim was to evaluate whether elective labor induction in nulliparous women increases the risks of symptomatic urinary incontinence (UI), anal incontinence (AI), or pelvic organ prolapse (POP) 4 years after delivery. In this single-site follow-up study of "A Randomized Trial of Induction Versus Expectant Management" (ARRIVE) that randomized low-risk nulliparous women with a singleton fetus to elective induction of labor versus expectant management, we compared pelvic floor symptoms between groups at a median of 4 years (interquartile range, 3.5-5.3) after first delivery using validated questionnaires. Seventy hundred sixty-six of 1,042 (74%) original participants responded, and 647 participants (62%) were included in the analysis after exclusions. The overall prevalence rates of symptomatic moderate to severe UI, AI, and POP were 21%, 14%, and 8%, respectively. There were no significant differences in any of the outcomes between women randomized to induction of labor and those to expectant management, either in unadjusted or adjusted analyses. There were also no differences in secondary outcomes, including subtypes of UI or flatal versus stool incontinence. In this single-site study, we found no significant differences in any UI, AI, and POP symptoms between nulliparous women randomized to elective induction of labor and to expectant management; however, for the least frequent outcome (POP), meaningful differences cannot be ruled out.

Prediction models for postpartum stress urinary incontinence: A systematic review

BackgroundPostpartum stress urinary incontinence significantly impacts the quality of life and the physical and mental health of women. A reliable predictive model for postpartum stress urinary incontinence can serve as a preventive tool. Currently, there have been numerous studies developing predictive models to assess the risk of postpartum stress urinary incontinence, but the quality and clinical applicability of these models remain unknown. ObjectiveTo systematically review and evaluate existing models for predicting stressful postpartum risks. MethodsPubMed, EBSCO, The Cochrane Library, Embase, Web of Science, China National Knowledge Infrastructure, WanFang Data, SinoMed, and VIP Data databases were systematically searched from the time of database construction to October 2023. Two researchers used Critical appraisal and data extraction for systematic reviews of prediction modeling studies: the CHARMS checklist for data extraction. Three researchers used The Prediction Model Risk of Bias Assessment Tool (PROBAST) checklist for bias and applicability assessment. ResultsEight papers including ten postpartum stress urinary incontinence prediction models were finalized. The most common predictors in the prediction models were urinary incontinence (UI) during pregnancy, followed by mode of delivery, Maternal age, parity, and UI before pregnancy. Nine of the prediction models reported discrimination with an area under the ROC curve (AUC) or C-index between 0.680 and 0.850. All included studies were at high risk of bias, mainly due to mishandling of continuous predictors, unreported or mishandled missing data, and inadequate assessment of predictive model performance. ConclusionsPostpartum stress urinary incontinence risk prediction models are in the initial development stage, and existing prediction models have a high risk of bias and poor modeling methodological quality, which may hinder their clinical application. In the future, healthcare practitioners should follow the norms of predictive model development and reporting to develop risk prediction models with superior predictive performance, low risk of bias, and easy clinical application.

Association between serum cotinine levels and urinary incontinence in adults in the United States: a population-based cross-sectional analysis

Environmental tobacco smoke (ETS) exposure has been shown to be associated with a variety of diseases, but evidence regarding the association between it and urinary incontinence (UI) is limited. Cotinine, a metabolite of nicotine in the human body, can more accurately quantify the level of human exposure to tobacco smoke. The study utilized data from seven survey cycles (2007-March 2020 Pre-pandemic) of the National Health and Nutrition Examination Survey (NHANES) program. Weighted multivariable logistic regression analysis, subgroup analysis, interaction tests, smooth curve fitting, and threshold effect models were used to analyze the relationship between serum cotinine and UI. Additionally, a 1:1 nearest neighbor propensity score matching (PSM) method was employed to minimize the impact of confounding factors. Before and after PSM, serum cotinine levels were higher in individuals with UI than those without (P < 0.05). Both before and after PSM, UI was positively correlated with serum cotinine levels, with a significantly increased risk of urinary incontinence when serum cotinine levels were in the Q3 range (before PSM: OR = 1.89, 95% CI = 1.59–2.24; after PSM: OR = 1.60, 95% CI = 1.28-2.00). Smooth curve fitting before and after PSM showed an approximate J-shaped non-linear dose-response relationship between log-transformed serum cotinine levels and UI. This study indicates that among American adults, there is a positive relationship between serum cotinine levels and UI, which is also significant in self-reported non-smoking populations. Therefore, reducing exposure to environmental tobacco smoke (e.g., avoiding second-hand smoke) in work and daily life may help alleviate the occurrence of UI, and serum cotinine levels have the potential to be a tool for predicting the degree of risk of developing UI.

Risk Factors for Urinary Incontinence in the Elderly

Individuals aged sixty years or older who require more care are referred to as seniors. Urinary incontinence in the elderly is a common problem. Uncontrolled urine production is known as urinary incontinence. Elderly people often experience this health problem. As we age, pelvic muscles weaken, resulting in changes in the anatomical function of the urinary tract organs and an increased risk of urinary incontinence. The aim of the research is to review related research on risk factors for urinary incontinence in the elderly. This research uses literature study. Where using a search for journals in Indonesian and English for 2013 - 2023 which was carried out using the WHO, PubMed, NCBI databases with the keywords Urinary incontinence in the elderly and found 10 journals selected according to the inclusion criteria with elderly subjects ≥ 45 years, cross sectional design and descriptive. The results show that urinary incontinence in the elderly has a significant relationship with risk factors for urinary incontinence such as diabetes, smoking, vaginal delivery and quality of life in the elderly. It can be concluded that there is a relationship between the two variables and most studies show that urinary incontinence is an important factor that can cause stress in the elderly.

Exploring the Genetic Risk of Childhood Daytime Urinary Incontinence: A Genome-Wide Association Study.

Childhood incontinence is stigmatized and underprioritized, and a basic understanding of its pathogenesis is missing. Our goal was to identify risk-conferring genetic variants in daytime urinary incontinence (DUI). We conducted a genome-wide association study in the Danish iPSYCH2015 cohort. Cases (3024) were identified through DUI diagnosis codes and redeemed prescriptions for DUI medication in children aged 5 to 20. Controls (30,240), selected from the same sample, were matched to cases on sex and psychiatric diagnoses, if any, and down-sampled to a 1:10 case:control ratio. Replication was performed in the Icelandic deCODE cohort (5475 cases/287,773 controls). Single-nucleotide polymorphism heritability was calculated using the genome-based restricted maximum likelihood method. Cross-trait genetic correlation was estimated using linkage disequilibrium score regression. Polygenic risk scores generated with LDpred2-auto and BOLT-LMM were assessed for association. Variants on chromosome 6 (rs12210989, OR = 1.24 [95% CI: 1.17-1.32], P = 3.21 × 10-12) and 20 (rs4809801, OR = 1.18 [95% CI: 1.11-1.25], P = 3.66 × 10-8) reached genome-wide significance and implicated the PRDM13 and RIPOR3 genes. Chromosome 6 findings were replicated (P = .024, OR = 1.09 [95% CI: 1.01-1.16]). Liability scale heritability ranged from 10.20% (95% CI: 6.40%-14.00%) to 15.30% (95% CI: 9.66%-20.94%). DUI and nocturnal enuresis showed positive genetic correlation (rg = 1.28 ± 0.38, P = .0007). DUI was associated with attention-deficit/hyperactivity disorder (OR = 1.098 [95% CI: 1.046-1.152], P < .0001) and body mass index (OR = 1.129 [95% CI: 1.081-1.178], P < .0001) polygenic risk. Common genetic variants contribute to the risk of childhood DUI and genes important in neuronal development and detrusor smooth muscle activity were implicated. These findings may help guide identification of new treatment targets.

Hysterectomy is not associated with increased risk of urinary incontinence-a northern Finland birth cohort 1966 study.

Hysterectomy has been suggested to increase the risk of urinary incontinence (UI), although evidence is controversial. In our population-based cohort study, we aimed to assess the independent effect of hysterectomy on the risk of de novo UI. This is a population-based cohort study on the women of the Northern Finland Birth Cohort 1966 (n = 5889). We identified all hysterectomies among the cohort (n = 461) using the national Care Register for Health Care and classified them according to surgical approach into laparoscopic (n = 247), vaginal (n = 107), and abdominal hysterectomies (n = 107). Women without hysterectomy formed the reference group (n = 3495). All women with UI diagnoses and operations were identified in the register, and women with preoperative UI diagnosis (n = 36) were excluded from the analysis to assess de novo UI. Data on potential confounding factors were collected from registers and the cohort questionnaire. Incidences of different UI subtypes and UI operations were compared between the hysterectomy and the reference groups, and further disaggregated by different hysterectomy approaches. Logistic regression models were used to analyze the association between hysterectomy and UI, with adjustments for several UI-related covariates. We found no significant difference in the incidence of UI diagnoses or the rate of subsequent UI operations between the hysterectomy and the reference groups (24 [5.6%] vs. 166 [4.7%], p = 0.416 and 14 [3.3%] vs. 87 [2.5%], p = 0.323). Hysterectomy was not significantly associated with the risk of any subtype of UI (overall UI: OR 1.20, 95% CI 0.77-1.86; stress UI (SUI): OR 1.51, 95% CI 0.89-2.55; other UI: OR 0.80, 95% CI 0.36-1.74). After adjusting for preoperative pelvic organ prolapse (POP) diagnoses, the risk was decreased (overall UI: OR 0.54, 95% CI 0.32-0.90; other than SUI: OR 0.40, 95% CI 0.17-0.95). Regarding different hysterectomy approaches, the risks of overall UI and SUI were significantly increased in vaginal, but not in laparoscopic or abdominal hysterectomy. However, adjusting for preoperative POP diagnosis abolished these risks. Hysterectomy is not an independent risk factor for de novo UI. Instead, underlying POP appears to be a significant risk factor for the incidence of UI after hysterectomy.

Risk factors for postpartum stress urinary incontinence: An updated systematic review and meta-analysis

&lt;b&gt;Background:&lt;/b&gt; The objective of this meta-analysis was to identify and quantify postpartum stress urinary incontinence (SUI) risk factors.&lt;br /&gt; &lt;b&gt;Methods:&lt;/b&gt; We systemically searched three electronic databases (PubMed, Scopus, and Web of Science). The evaluated variables as risk factors were pooled as odds ratio (OR) with the corresponding 95% confidence intervals (CI).&lt;br /&gt; &lt;b&gt;Results:&lt;/b&gt; 63 studies were included. The analysis found a significant positive association between SUI and vaginal delivery (OR=2.15), age (OR=1.44), BMI (OR=1.19), parity (OR=1.43), and fetal-birth weight (OR=1.08).&lt;br /&gt; &lt;b&gt;Conclusions:&lt;/b&gt; Age, parity, delivery with forceps, birth weight, maternal body mass index, induction of labor, length of the second stage of labor, history of prenatal SUI, and vaginal delivery were all risk factors for postpartum SUI.&lt;br /&gt; &lt;b&gt;Scientific novelty:&lt;/b&gt; This systematic review and meta-analysis provides the most comprehensive and updated evidence to date.&lt;br /&gt; &lt;b&gt;Practical significance of the results:&lt;/b&gt; Healthcare personnel should be taught to recognize and treat postpartum SUI risk factors.

Later-age neutering causes lower risk of early-onset urinary incontinence than early neutering-a VetCompass target trial emulation study.

There is growing evidence supporting clinically important associations between age at neutering in bitches and subsequent urinary incontinence (UI), although much of this evidence to date is considered weak. Target trial emulation is an innovative approach in causal inference that has gained substantial attention in recent years, aiming to simulate a hypothetical randomised controlled trial by leveraging observational data. Using anonymised veterinary clinical data from the VetCompass Programme, this study applied the target trial emulation framework to determine whether later-age neutering (≥ 7 to ≤ 18 months) causes decreased odds of early-onset UI (diagnosed < 8.5 years) compared to early-age neutering (3 to < 7 months). The study included bitches in the VetCompass database born from January 1, 2010, to December 31, 2012, and neutered between 3 and 18 months old. Bitches were retrospectively confirmed from the electronic health records as neutered early or later. The primary outcome was a diagnosis of early-onset UI. Informed from a directed acyclic graph, data on the following covariates were extracted: breed, insurance status, co-morbidities and veterinary group. Inverse probability of treatment weighting was used to adjust for confounding, with inverse probability of censoring weighting accounting for censored bitches. The emulated trial included 612 early-age neutered bitches and 888 later-age neutered bitches. A pooled logistic regression outcome model identified bitches neutered later at 0.80 times the odds (95% CI 0.54 to 0.97) of early-onset UI compared with bitches neutered early. The findings show that later-age neutering causes reduced odds of early-onset UI diagnosis compared with early-age neutering. Decision-making on the age of neutering should be carefully considered, with preference given to delaying neutering until after 7 months of age unless other major reasons justify earlier surgery. The study is one of the first to demonstrate successful application of the target trial framework to veterinary observational data.

Reduction of lower urinary tract symptoms in prostate cancer patients treated with robot assisted laparoscopic prostatectomy.

The aim of this study was to evaluate the change in LUTS in patients treated with RALP and to assess factors that may predict an improvement of LUTS. In our institutional prospective research registry, 1935 patients operated in the period between 2009 and 2021 with complete baseline- and 12-month EPIC-26 questionnaire were eligible for the study. Also SF-12 data estimating general quality of life (QoL) were analyzed. A LUTS summary score was constructed from the two questions concerning voiding stream/residual and frequency, and transformed linearly to a 0-100 scale with higher scores representing less symptoms A change of 6 points or more were considered Meaningful Clinical Differences (MCD). Two summary scores were calculated from the SF-12 - a mental component score (MCS-12) and a physical component score (PCS-12). Multivariate regression was used to estimate covariates associated with postoperative MCD, MCS-12 and PCS-12. Mean change of LUTS-score showed an increase of 10 points 12-months post-RALP. 52% of patients achieved MCD. In multivariate logistic regression, preoperative LUTS was statistically significant associated with MCD. Reduction of LUTS was associated improved mean score of MCS-12 and PCS-12. Along with information about risk for urinary incontinence after RALP, patients with LUTS at baseline must be informed that these symptoms may be reduced after RALP. In our study, this LUTS reduction was associated with better general QoL.

Associations of Blood and Urinary Heavy Metals with Stress Urinary Incontinence Risk Among Adults in NHANES, 2003-2018.

People come into contact with heavy metals in various ways in their daily lives. Accumulating evidence shows that toxic metal exposure is hazardous to human health. However, limited information is available regarding the impact of metal mixtures on stress urinary incontinence (SUI). Therefore, we used data from 10,622 adults from the 2003-2018 National Health and Nutrition Examination Survey (NHANES) to investigate the independent and comprehensive association between heavy metal co-exposure and SUI. Among them, 2455 (23.1%) had been diagnosed with SUI, while the rest had no SUI. We evaluated the independent and combined associations of 3 blood metals and 10 urinary metals with SUI risk, along with subgroup analyses according to age and gender. In the single-exposure model, blood cadmium (Cd), lead (Pb), mercury (Hg), urinary Cd, Pb, and cesium (Cs) were found to be positively connected with SUI risk. Moreover, weighted quantile sum (WQS) regression, quantile-based g-computation (qgcomp), and Bayesian kernel machine regression (BKMR) consistently demonstrated blood and urinary metal-mixed exposure were positively associated with the risk of SUI, and emphasized that blood Pb and Cd and urinary Cd and Cs were the main positive drivers, respectively. This association was more pronounced in the young and middle-aged group (20-59years old) and the female group. Nevertheless, further research is necessary to validate these significant findings.

Association of plasma high-density lipoprotein cholesterol level with risk of stress urinary incontinence in women: a retrospective study

BackgroundStudies have found that high density lipoprotein cholesterol (HDL-C) levels are linked to a variety of diseases. However, evidence for the relationship between stress urinary incontinence (SUI) and HDL-C remain limited.Methods590 eligible women were enrolled. Basic characteristic, gynecological examinations and blood sampling were collected. The examination of the possible link between HDL-C and SUI was done using univariate and multivariate logistic regression. Feature importance ranking and Receiver operating characteristic (ROC) curves were performed to further evaluate the association between HDL-C and SUI in women.ResultsA significant association was found between HDL-C and SUI in women, revealing higher HDL-C levels were related to a lower risk of SUI (OR 0.238; 95%CI: 0.091–0.623; P < 0.01) after adjustment for potential key confounders. The AUC for the SUI predicted by the combined HDL-C was 0.845 (95%CI: 0.798–0.891, P < 0.001). The feature importance ranking revealed that vaginal delivery, HDL-C were the top two important factors.ConclusionsHDL-C levels were correlated with the development of SUI. In addition to physical and surgical treatments, HDL-C may offer the possibility of potential targeted treatment and prevention of SUI afterwards.

Effects of Internal Iliac Artery Ligation on Stress and Urge Incontinence: A Retrospective Evaluation.

Does bilateral internal iliac artery ligation (BIIAL), a fundamental intervention in the treatment of postpartum hemorrhage, increase the risk of urinary incontinence (UI)? This study aims to shed light on the effects of BIIAL on bladder perfusion and urinary system integrity, thereby elucidating urinary function disorders following pelvic surgery. Demographic and medical data were collected from a total of 192 female patients, with and without the application of BIIAL. Urinary incontinence conditions were assessed using the Questionnaire for Urinary Incontinence Diagnosis (QUID) test. The data collection process was conducted according to ethical standards, and the results were analyzed to determine the types of incontinence. In the group that underwent BIIAL, the number of pregnancies and births was statistically higher compared to the control group. A significant effect of BIIAL was seen in cases of urge urinary incontinence (UUI), while no meaningful impact was detected on stress urinary incontinence (SUI). After the BIIAL procedure, an increase in the rate of urinary leakage was seen in certain cases. Bilateral internal iliac artery ligation has proven to be a safe and effective intervention in the management of postpartum hemorrhage. The findings suggest a potential impact of BIIAL on UUI but not on SUI. Comprehensive and long-term prospective studies are needed to further investigate the effects of BIIAL on pelvic blood flow and bladder functions.