SUI Symptoms Research Articles

Novel Method of Measuring Pelvic Floor Muscle Motion May Improve Accessibility of Pelvic Floor Muscle Coordination Training.

Pelvic floor muscle ultrasound is an important clinical tool for improving motor coordination and even strength. Although the gold standard approach involves transperineal probe placement, this is not always feasible with sensitive populations, requires privacy owing to probe placement, and additional sonography training. This article introduces a novel transabdominal method for measuring pelvic floor muscle motion that incorporates a reference point within the bladder. The hypothesis is that the novel measurement will correlate positively with transperineal measurements. A total of 55 women (15 nulliparous, 40 parous; 20 continent, 35 incontinent) performed pelvic floor muscle contraction and strain. Transabdominal ultrasound measured bladder diagonal length (BDL) and transperineal ultrasound measured bladder neck height (BNH), levator plate length (LPL), and levator plate angle (LPA). Spearman's test measured the correlation between the measurement outcomes and an independent t test compared outcomes based on parity and stress urinary incontinence symptom status. Spearman's correlation showed moderate positive correlations between the pelvic floor measurements for both tasks, which reduced slightly when grouping by parity and symptom status. Group differences were significant for BDL during the muscle contraction, factoring in SUI symptoms (p = 0.019) and parity status (p = 0.005) and LPL during contraction, factoring in parity status (p = 0.033). BDL correlates with BNH, LPL, and LPA with slightly reduced correlation when factoring in parity and continence status. The advantages of the method include accessibility for sensitive populations, nontraditional positions due to the anatomical reference point, functional locations due to limited privacy needs, and minimal training required for pelvic floor therapists to incorporate into rehabilitation.

Babcock versus Scissor Tensioning for Retropubic Mid-Urethral Slings: Comparing Two Intra-Operative Techniques Through 5 Years of Follow-Up.

The objective was to determine if mid-urethral sling (MUS) tensioning with a Mayo Scissor as a sub-urethral spacer compared with a Babcock clamp holding a loop of tape under the urethra results in differences in patient-reported outcomes and rates of repeat surgery over a 5-year follow-up. Follow-up 5 years after a randomized clinical trial, utilizing primary data collection linked to administrative health data, was carried out to create a longitudinal cohort. The primary outcome was participant-reported bothersome SUI symptoms, as defined by the Urogenital Distress Inventory (UDI-6) questionnaire. Secondary outcomes included participant-reported bothersome overactive bladder (OAB) scores, median scores of three validated urinary symptom questionnaires, and rates of subsequent surgery determined through patient report and administrative data. Two hundred and sixty (81.8%) of the original study participants provided participant-reported data at 5 years. Administrative data linkage was completed for all of the original participants (n = 318). Demographic characteristics remained similar in the two groups at the 5-year follow-up mark. No differences existed in the primary outcome of reported bothersome SUI symptoms (30.8% Scissors vs 26.8% Babcock, p = 0.559), proportion of participants with bothersome OAB, the median scores of three validated bladder questionnaires, or in rates and cumulative incidence of recurrent MUS surgery or surgical revision of mesh-related complications. Both the Scissor and Babcock tensioning techniques provided comparable outcomes at 5 years post-MUS surgery. The information from this study allows surgeons to better decide which technique to adopt in their practice, providing confidence in longer-term cure and safety.

Pelvic floor muscle training in female functional fitness exercisers: an assessor-blinded randomised controlled trial

ObjectiveStress urinary incontinence (SUI) is common among females during functional fitness training, such as CrossFit. The aim of this study was to assess the effect of pelvic floor muscle training...

Association between Sitting Time and Urinary Incontinence in the US population: Data from the National Health and Nutrition Examination Survey (NHANES) 2007 to 2018

BackgroundUrinary incontinence (UI) is a common health problem that affects the quality of life and health of millions of people in the United States (US). We aimed to investigate the association between sitting time and UI symptoms in the US population. MethodsA cross-sectional survey of participants aged 20 and above from the National Health and Nutrition Examination Survey 2007–2018 was performed. A self-report questionnaire that reported complete data on UI, sitting time and covariates was included. Weighted multivariable logistic and regression models were used to assess the association between sitting time and UI symptoms. ResultsA total of 22,916 participants were enrolled. Prolonged sitting time was associated with urgency UI (UUI, odds ratio [OR] = 1.2, 95% confidence interval [CI] = 1.1 to 1.3, p = 0.001). Compared with patients with sitting a time shorter than 7 hours (h), moderate recreational activity modified the association between sitting time and mixed UI in males in the fully adjusted model (OR = 2.5, 95% CI = 1.4 to 4.5, p = 0.002). A sitting time over 7 h was related to mixed UI (MUI, OR = 1.6, 95% CI = 1.1 to 2.2, p = 0.01) in males, and stress UI (SUI, OR = 0.9, 95% CI = 0.8 to 0.98, p = 0.03) in females. However, no significant difference was found among the UI, SUI, and MUI groups in fully adjusted model. ConclusionsA prolonged sitting time (≥7 h) was associated with UUI symptoms in all populations, SUI symptoms in females and MUI symptoms in males compared with sitting time lower than 7 h. Compared with those sit shorter than 7 h, moderate recreational activity may be a modifier between prolonged sitting and MUI symptoms in male participants, which warrants further studies for confirmation.

The effect of injectable platelet rich fibrin as a nonsurgical treatment of the female stress urinary incontinence.

The complications of surgical treatments of stress urinary incontinence have led to the search for less invasive and safer treatment procedures. We aimed to investigate the efficacy of locally administered injectable platelet-rich fibrin (i-PRF), an autologous material that plays an important role in tissue regeneration, in women with stress urinary incontinence. Thirty-four women were included in this prospective, single-center, and interventional study, suffering from stress urinary incontinence refractory to conservative treatment. Three consecutive i-PRF injections were applied to the mid-urethra localization at anterior vaginal wall with an interval of 1month. ICIQ-SF, UDI-6, IIQ-7 and POPDI-6 questionnaires were used to measure pre‑treatment, 1month and 6months post‑treatment symptom severity and the clinical outcomes were recorded. The mean age of the patients was 51.5 ± 9.8years. ICIQ-SF, UDI-6, IIQ-7 and POPDI-6 questionnaires results revealed significant clinical improvement of stress urinary incontinence severity afer the administration of i-PRF (p < 0.001). The results at 1 and 6months after treatment did not change statistically significantly. This study demonstrated that locally administiration of i-PRF is efective in relieving SUI symptoms with high success rates without any adverse effects reported. i-PRF injection may have the potential to be a novel, minimally invasive, and low-risk procedure, that could be an alternative and simple treatment modality to surgery for female patients with stress urinary incontinence. Additionally, it may create new avenues for research on therapeutic implementation of i-PRF.

The Evaluation of the Effect of Suburethral Transobturator Sling on the Urethra Using Ultrasound Examination

Abstract Background Despite the use of suburethral tapes for many years, the mechanism of their action and the reasons for their failures have not been thoroughly understood. Objectives The aim of this study was to analyze the impact of the TOT tape on changes in urethral mobility depending on its location. Additionally, the urethral funneling was evaluated. Material and methods 57 patients with SUI symptoms had TOT implanted. Ultrasound examinations were performed before and 3–6 months after surgery, among others, urethral length, suburethral tape location, bladder neck mobility, and urethral funneling were evaluated. Results 77.2% of patients were cured, while 22.8% were not cured. After tape insertion, a reduction in bladder neck mobility parameters was observed in the group of patients with preoperative hypermobile urethras, regardless of the therapeutic outcome. The average distance of the tape from the hypoechoic area of the urethra was smaller in cured patients, while the relative tape position did not differ significantly between cured and not cured women. Before surgery, all patients had a long urethral funneling. Postoperatively, all non‑cured patients had a long funneling, while in cured patients, no long urethral funneling was observed. Conclusions The TOT suburethral tape reduced urethral mobility to a similar extent in cured and not cured women. The effect on UM was noticeable in patients with preoperative hypermobile urethrae. The obtained TOT tape locations did not affect the degree of UM reduction. Patients in whom the TOT tape was located closer to the hypoechoic zone of the urethra had a greater chance of effective elimination of SUI symptoms. It was confirmed that the assessment of the urethral funneling during PFS ‑TV may be useful for confirming SUI and for assessing the effects of SUI treatment after suburethral tape implantation.

Effect of home-based core exercises on postpartum stress urinary incontinence during COVID-19 pandemic in Jeddah city: a randomised control trial

IntroductionIntroduction. Postpartum stress urinary incontinence affects many women worldwide; it may exist during pregnancy or postpartum with a risk of permanence increasing five years later. This study aimed to determine the effect of home-based core exercises on postpartum stress urinary incontinence during the COVID-19 pandemic, in Jeddah city.MethodsRandomised control trial was conducted on 26 postpartum women aged 25–40 years with mild or moderate grade stress urinary incontinence and a body mass index (BMI) less than 30 kg/m2. Participants were randomly divided into two equal groups (A &amp; B). Group A performed home-based core exercises and pelvic floor muscle training for twenty-four sessions three times weekly for eight weeks; each session lasted 30 minutes. Group B performed home-based PFMT only. The assessment of pelvic floor muscles (PFMs) was measured with the Modified Oxford Grading Scale, while the 1-hour pad test and International Consolation on Incontinence questionnaire-short form (ICIQ UI- SF) total score served to assess incontinence severity before and after treatment.ResultsThe results showed a significant improvement in PFMs strength and endurance in both groups and there was a highly significant difference between groups, favouring the study group (A). There was a highly significant difference between the groups in the 1-hour pad test and ICIQ-SF total score, favouring the study group (A).ConclusionsHome-based core exercises for postpartum SUI women were an effective method to improve PFMs strength and endurance and minimise SUI symptoms.

The prevalence and risk factors of different degrees of stress urinary incontinence in Chinese women: A community-based cross-sectional study.

To investigate the prevalence of SUI and explore the factors that could influence the severity of SUI in adult females. A cross-sectional study. A total of 1178 subjects were assessed using a risk-factor questionnaires and International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF) and then divided into no SUI group, mild SUI group and moderate-to-severe SUI group according to the ICIQ-SF score. Univariate analysis between adjacent groups and ordered logistic regression models in three groups were then performed to analysis the possible associated factor with the progressive of SUI. The prevalence of SUI among adult women was 22.2% of them; 16.2% and 6% had mild SUI and moderate-to-severe SUI, respectively. Moreover, logistic analysis revealed that age, BMI, smoking, position preference for urination, urinary tract infections, urinary leaks during pregnancy, gynaecological inflammation and poor sleep quality were independent risk for the severity of SUI. SUI symptoms were mostly mild among Chinese females, specific risk factors such as unhealthy living habits and urination behaviours increased the risk of SUI and the aggravation of symptoms. Therefore, targeted interventions should be formulated for women to delay disease progression.

MP37-06 VALIDATION OF THE LURN SI-10 QUESTIONNAIRE IN WOMEN UNDERGOING MIDURETHRAL SLING SURGERY

You have accessJournal of UrologyCME1 Apr 2023MP37-06 VALIDATION OF THE LURN SI-10 QUESTIONNAIRE IN WOMEN UNDERGOING MIDURETHRAL SLING SURGERY Grace Lai, Joel Vetter, and H Henry Lai Grace LaiGrace Lai More articles by this author , Joel VetterJoel Vetter More articles by this author , and H Henry LaiH Henry Lai More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003275.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The LURN SI-10 (10-item LURN Symptom Index) was developed by the Symptoms of Lower Urinary Tract Dysfunction Research Network (LURN) to measure LUTS in men and women (Cella et al 2019). LURN SI-10 consists of ten items on LUTS, plus an additional question on global urinary bother. Two of the items focus on stress urinary incontinence with coughing/sneezing/laughing (SUI-1), and SUI with physical activities (SUI-2). Here we validate and evaluate the responsiveness of the LURN SI-10 questionnaire by comparing patients’ responses before and after midurethral sling surgery. METHODS: Adult women completed the LURN SI-10 and Urinary Distress Inventory (UDI-6) questionnaires before and after midurethral sling surgery (retropubic or trans-obturator TVT). Mean change in total LURN SI-10, SUI-1 and SUI-2 scores after surgery, paired t-tests, effect sizes (ES) of the change, and standardized response means (SRM) were tabulated. For ES and SRM, value of 0.5 to 0.7 is considered moderate responsiveness, 0.8 to 1.0 is considered good, and values >1.0 is considered excellent responsiveness to change. LURN SI-10 scores were compared to scores on the UDI-6. RESULTS: Total LURN SI-10, SUI-1 and SUI-2 scores on LURN SI-10 decreased by 59%, 85% and 90% respectively after midurethral sling surgeries (n=37, all p<0.001, paired t-tests, see Table 1). The effect sizes (ES) of the changes for SUI-1 and SUI-2 were 3.03 and 2.19 respectively, indicating excellent responsiveness to change to known effective treatments of SUI. The standardized response means (SRM) were 2.14 and 2.11 respectively, again indicating excellent responsiveness to change. The ES of SUI-1 was greater than the ES of UDI-6. The SRM of SUI-1 and SUI-2 were both greater than UDI-6. There were strong correlations between LURN SI-10 and UDI-6 before and after surgery (r=0.84 and 0.65 respectively, p both <0.01). CONCLUSIONS: The two stress urinary incontinence questions (SUI-1, SUI-2) on LURN SI-10 questionnaire were responsive to change to known effective treatments of SUI, and may be used to assess SUI symptom change or improvement after SUI treatments. Source of Funding: Midwest Stone Institute © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e515 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Grace Lai More articles by this author Joel Vetter More articles by this author H Henry Lai More articles by this author Expand All Advertisement PDF downloadLoading ...

Safety, tolerability and short-term efficacy of transvaginal fractional bipolar radiofrequency therapy for symptoms of stress and or mixed incontinence in conjunction with genitourinary syndrome of menopause.

Radiofrequency (RF) energy application stimulates collagen and elastin remodeling to restore the elasticity, and moisture of the superficial vaginal mucosa. This is the first study to report on the use of microneedling to deliver RF energy to the vaginal canal. Microneedling increases the response of the collagen contraction and neocollagenesis in deeper layers of tissue, thus increasing the support to the surface. The novel intravaginal microneedling device used in this study allows penetration of the needles to 1, 2, or 3 mm. A prospective study to evaluate the safety and short-term outcome of a single fractional RF treatment of the vaginal canal in a series of women with coexistent stress or mixed incontinence (MUI) and genitourinary syndrome of menopause (GSM). Twenty women who had symptoms of SUI and or MUI in conjunction with GSM were given a single vaginal treatment that consisted of fractional bipolar RF energy using the EmpowerRF platform with the Morpheus8V applicator (InMode). RF energy was delivered into the vaginal walls via 24 microneedles, at a depth of 1, 2, and 3 mm. Outcomes were evaluated by "cough" stress test, questionnaires (MESA SI, MESA UI, iQoL, UDI-6) and evaluation of vaginal tissue through the VHI scale at 1-, 3-, and 6-months post-treatment compared to baseline. Biopsies were performed at baseline and 3-months on five patients for histological reference and tissue evaluation. Eight out of eight outcomes measured from baseline to 6-months post-treatment showed improvement. The parameters scored in the questionnaires including frequency, urgency, nocturia, urge incontinence, and stress incontinence showed significant improvement in all areas at the 1-, 3-, and 6-month follow-up sessions compared to baseline. The results showed evidence that fractional RF energy delivered vaginally is safe, well tolerated, and provide short term improvement of SUI and or MUI in conjunction with GSM.

Periurethral and Anterior Vaginal Wall Masses: Etiology, Presentation, and Treatment Outcomes

ABSTRACT Periurethral and anterior vaginal masses are relatively common with an estimated prevalence of 3% to 4% and 1%, respectively. These masses often cause diagnostic challenges due to nonspecific and overlapping symptoms. Urinary symptoms include frequency, urgency, and dysuria; vaginal discharge, urinary tract infection (UTI), dyspareunia, bleeding, postvoid dribbling, pelvic and urethral pain, and palpable mass can also present. Familiarity with differentiation of masses is important to make timely diagnoses and to expedite treatment without delays. This study aimed to describe the etiology of periurethral and anterior vaginal wall masses in a large series, as well as report the clinical presentations to determine whether the differential diagnosis can be narrowed based on presenting symptoms. The study consisted of a retrospective chart review, based on charts of patients from November 2001 to July 2021 at a tertiary referral center. Analyzed data included age, body mass index, operative findings, operative time, concomitant procedures, pathologic diagnosis, catheterization time, complications, length of stay, symptoms on follow-up, and follow-up duration. Describing the etiology of periurethral and anterior vaginal wall masses was the primary objective of the study (including underlying etiology distribution), followed by the secondary objective of describing rates of other clinical characteristics. A systematic search of literature was performed using various databases: MEDLINE (Ovid), Cochran Central Register of Controlled Trials (Wiley Online Library), EMBASE (Elsevier), and Scopus. The study included a total of 126 patients, all with at least 1 symptom exhibited. The most common presenting symptoms were palpable mass, dyspareunia, and urinary tract symptoms (dysuria, stress urinary incontinence [SUI], and UTI). There was an infection rate of 21.4% and a malignancy rate of 1.6%. Each patient underwent surgical treatment, including urethral repair, periurethral cyst excision, urethral diverticulectomy, and lesion excision. A total of 29.4% of patients reported SUI preoperatively. Postoperatively, 105 patients reported no incontinence (83.3%), 15 reported SUI (11.9%), 5 reported mixed urinary incontinence (4%), and 1 presented with overflow incontinence (0.8%). Limitations of the study include the prospective collection of data but its retrospective analysis, thereby limiting findings according to the accuracy and completeness of the medical records. In addition, there was an absence of patient-reported outcome measures when SUI or other symptoms were assessed, and the authors recognize a need for future prospective studies to include such outcome measures. This large series evaluation of periurethral and anterior vaginal wall masses is the largest of its kind, as the previous study included only 79 patients with periurethral masses, 96% of whom had definitive pathological diagnoses and surgical treatment. This study provides a broad view into the etiological spectrum underlying periurethral and anterior vaginal masses. Malignancy is rare. Infectious pathology is common and found in 21.4% of patients, whereas urethral diverticulum was the most common pathology (40% of cases). Finally, this study indicated high success rates for surgical excisions, as there were no recurrences among diverticula patients in the study. For Skene’s gland cyst excisions, a recurrence rate of less than 1% was noted.

Prevalence of diastasis m. rectus abdominis and pelvic floor muscle dysfunction in postpartum women.

The aim of this study was to determine the prevalence of Diastasis of the rectus abdominis muscles (DRAM) and pelvic floor muscle dysfunction (PFMD) in postpartum women.Design: The observational prospective study. 150 of 180 women (83.3 %) from 6 weeks to 6 months postpartum, with a mean age of 33.1 years. For diastasis examination, inter recti distance (IRD) was measured by a linear 2D ultrasound probe, 4.5 cm above the navel, in its area and 4.5 cm below the navel when lying on the back at rest and under a load test. The degree of DRAM was classified intofour grades. Urinary leakage symptoms were assessed by the International Incontinence Consultation Questionnaire (ICIQ - UI SF). The first degree of diastasis during the load test was 38.1 % above the navel, 36.4 % in the navel area, and 23.7 % below the navel. The second degree of diastasis with load was 28.8 % above the navel, 21.2 % in the navel area, and 10.2 % below the navel. PFMD showed 31.3 % of women with mild symptoms of SUI, 32.2 % of women with grade 1 cystocele. The average IRD distance at rest and during the load test confirmed the first grade of DRAM out of four degrees of severity. Moderate and medium DRAM occurred according to location in an average of one-third of the cases. The highest percentage of DRAM was above the navel, and the lowest percentage below the navel. PFMD was detected in an average of one-third of cases. It is important to monitor these parameters with a view to improving the quality of life index in the future (Tab. 5, Ref. 22).

Comparison of Kegel exercises and a combination of Kegel exercises with the use of the KegelSmart biofeedback device in the treatment of static urinary incontinence.

Aim To determine which of the two methods, Kegel exercises or combination of Kegel exercises with the use of the KegelSmart biofeedback device, has better therapeutic effects on the symptoms of SUI in females. Methods Fifty female patients with SUI were randomly divided into two groups: 25 treated with Kegel exercises, and 25 with the combination of Kegel exercises with the use of the KegelSmart biofeedback device. Patients in both groups performed Kegel exercises 30 minutes daily for 30 days. Patients in the second group, in addition to Kegel exercises, applied the KegelSmart device intravaginally for 20 minutes daily for 30 days. All patients filled out a questionnaire based on 12 questions consisting of an objective and a subjective component. Results The basic characteristics of the patients from both groups were not statistically significantly different: age 55.16 vs 54.52 years; number of births 1.80 vs 1.96; body mass index 29.12 vs 28.40. There was a statistically significant reduction in the values of all analysed objective and subjective parameters in the group treated with combination of Kegel exercises with the use of the KegelSmart biofeedback device compared to Kegel exercises group. Conclusion Combination of Kegel exercises with the use of the KegelSmart biofeedback device has better therapeutic effects than Kegel exercises on the objective and subjective symptoms of SUI.

Femistina versus Canephron as a prevention of urinary tract infections after midurethral sling surgery – Non-inferiority study

ObjectiveUrinary tract infection (UTI) is relatively common post-operative complication following midurethral sling placement (MUS), even in cases where intraoperative antibiotic prophylaxis was given. The primary aim of this study was to investigate the non-inferiority of Femistina as compared with Canephron in reducing symptomatic UTI in first six months following surgery. Study designA sample size of 144 patients per group was established, to provide at least 90% power to demonstrate the non-inferiority of phytodrug Femistina versus Canephron as a prevention of post-MUS urinary tract infection. ResultsWomen suffering from stress urinary incontinence and mixed urinary incontinence (MUI) with predominant SUI symptoms as confirmed by urodymamics (n = 320) were randomized in a 1:1 ratio to Femistina (40 mg, oral, twice daily for 20 days) or Canephron (3 × 5 ml taken orally-three times daily for 4 weeks). Both groups were homogenous for age, type of operation (only TOT outside-in) and severity of illness as indicated by ICIQ-SF questionnaire. We found that symptoms of UTI were significantly lower in patients receiving Femistina. During first 6 months after surgery UTI was confirmed in only 10 patients receiving Femistina (6,25%) when compared to 25 (15,63%) subjects receiving Canephron, p < 0.007. ConclusionFemistina is not inferior to Canephron in preventing lower urinary tract infection after midurethral sling surgery.

Anatomical and symptomatic outcomes in patients with Le Fort colpocleisis with or without hysterectomy

BackgroundWe aimed to evaluate the short-term anatomical and clinical outcomes of elderly patients who underwent the Le Fort colpocleisis operation due to pelvic organ prolapse (POP) in our clinic.MethodsThe medical records of fifty-nine sexually inactive females, with stage 2 or higher vaginal or uterine prolapse who underwent Le Fort colpocleisis operations were prospectively analysed. Preoperative and 12th month postoperative data were recorded. Lower urinary tract symptoms (LUTS) was also evaluated preoperatively and 12 months postoperatively in all patients. Anatomical success was determined as no prolapse of any POP-Q point at or below 1 cm above vaginal introitus.ResultsA total of 59 patients were included in this study. The average age of the patients was 71.67 ± 7.01 (years). The mean BMI was 27.1 ± 9.52 kg/m2. POP-Q point, C (6.70 ± 2.44 vs. − 2.66 ± 1.21) measurements were significantly deeper, as well as Gh (4.83 ± 0.94 vs. 4.26 ± 0.94) and TVL (3.51 ± 1.24 vs. 8.93 ± 1.73) measurements were significantly higher after surgery than during the preoperative period (p < 0.01, p < 0.01, p < 0.01, respectively). There were no cases of recurrence. The evaluation of LUTS at the 12-months postoperative follow-up revealed significant differences for SUI, urinary frequency, nocturia, and pelvic pain symptoms (p = 0.007, p < 0.001, p = 0.01, p < 0.001, respectively).ConclusionsLe Fort colpocleisis is a simple and effective procedure that provides successful anatomical and clinical outcomes in sexually inactive and elderly women with POP. However, the long-term results of this procedure need further investigation.

Minimally Invasive Autologous Fascia Sling at the Midurethra: A Case Series

The primary objective was to determine the improvement in stress urinary incontinence symptoms using autologous fascia lata sling placed at the midurethra. The secondary objective was to determine the presence of leg pain after harvest of fascia lata graft. Case series. Rural academic tertiary care center. All women who underwent an autologous fascia midurethral sling over a 1-year period between June 2019 and September 2020. Autologous fascia lata midurethral sling. Incontinence severity index, urodynamic distress inventory-6, and Likert pain scale. Nineteen women received an autologous fascial sling at the midurethra using the described technique-16 fascia lata and 3 rectus fasciae. Mean improvement in incontinence severity index score was 6 points. Mean improvement in urodynamic distress inventory-6 and SUI subscale scores was 14 and 53, respectively, surpassing the minimally important difference for each. Median follow-up time was 9 months (range 2-16). Leg pain at the harvest site was bothersome in 1 patient beyond 6 weeks. Median time to passing voiding trial was 4 days (range 1-13 days). Four patients (21%) had postoperative voiding dysfunction, 3 of which resolved after sling loosening at a mean of 60 days after sling placement. Midurethral autologous fascial sling placement significantly improves symptoms of SUI but carries a risk of voiding dysfunction. Harvesting fascia lata using a fascial stripper is associated with minimal postoperative morbidity.

MP52-20 THE IMPACT OF LOWER URINARY TRACT SYMPTOMS (LUTS) ON DEPRESSION AND DEPRESSIVE SYMPTOMS AMONG WOMEN 20-69 YEARS

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Female Incontinence: Therapy II (MP52)1 Sep 2021MP52-20 THE IMPACT OF LOWER URINARY TRACT SYMPTOMS (LUTS) ON DEPRESSION AND DEPRESSIVE SYMPTOMS AMONG WOMEN 20-69 YEARS Stephanie Gleicher, Timothy Byler, and Natasha Ginzburg Stephanie GleicherStephanie Gleicher More articles by this author , Timothy BylerTimothy Byler More articles by this author , and Natasha GinzburgNatasha Ginzburg More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002082.20AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Studies have shown that women with LUTS have higher rates of depression, anxiety, and overall worse health perception. Correlations have been shown between symptom severity and worsened mental health status. The aim of this study was to compare the impact of varying urinary symptoms, such as SUI, UUI, and nocturia, on depression and depressive symptoms among women aged 20-69 years. METHODS: We queried NHANES between 2013-2018 for women aged 20-69 years. We defined SUI as “leakage during physical activity”, UUI as “leakage during non-physical activity” and nocturia as “≥ 2 voids/night”. Depression was defined by DSM criteria with cases reporting ≥5 symptoms from the patient health questionnaire (PHQ9) depression screening tool. We assessed various demographic and clinical variables such as age, race, education, insurance status, smoking status, hypertension (HTN), hyperlipidemia (HLD), body mass index (BMI), hemoglobin A1c (HbA1c), perceived heath status, and visits to mental health providers. We performed univariate analysis and multivariable logistic regression. RESULTS: Of the 6284 participants, 27% reported nocturia, 42% had SUI, and 9% had UUI. Depression was found in 5% of the cohort. Women with depression were significantly less educated, had less health insurance, more commonly smoked, had HTN and HLD, had higher BMI, and had higher HbA1c. Depressed women were twice as likely to have nocturia (51% vs 26%, p<0.001). 64% of depressed women had SUI and 21% had UUI (p<0.001). Depressed women were three times more likely to have negative health perception (36% vs 9%, p<0.001). Multivariate regression revealed increased risk of depression among women with SUI (OR 1.79, p=0.004) and nocturia (OR 1.65, p=0.007), but not UUI. While evaluating the impact of specific PHQ9 elements and SUI, multivariate analysis revealed significant correlations with “feeling tired” (OR 1.26) and suicidal ideation (OR 1.77). Nocturia and depression were significantly correlated with decreased interest (OR 1.39), poor sleep (OR 1.71), “feeling tired” (OR 1.26) and changes in appetite (OR 1.37). CONCLUSIONS: SUI and nocturia appear to be significantly associated with depression and depressive symptoms. These findings reinforce that LUTS cannot be considered an isolated symptom, but a factor impacting overall mental-health wellbeing. Source of Funding: N/A © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e938-e938 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Stephanie Gleicher More articles by this author Timothy Byler More articles by this author Natasha Ginzburg More articles by this author Expand All Advertisement Loading ...

Mobile App-Based Intervention for Pregnant Women With Stress Urinary Incontinence: Protocol for a Hybrid Effectiveness-Implementation Trial.

BackgroundStress urinary incontinence (SUI) is a common source of distress among women during and after pregnancy. It has a negative effect on quality of life but with poor care-seeking. Mobile health (mHealth) may be a promising solution with potential advantages. However, there is uncertainty whether a mobile app is effective for SUI symptom improvement during and after pregnancy. The implementation is also unclear. We developed an app named UIW (Urinary Incontinence for Women) aimed at improving perinatal incontinence.ObjectiveThe objective of this study is to evaluate the effectiveness of the UIW app-based intervention in improving SUI symptoms among pregnant women and explore the facilitators and barriers to using the UIW app to help refine and optimize the intervention.MethodsThis study is a hybrid effectiveness-implementation trial with a randomized controlled trial alongside a mixed-methods process evaluation according to the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. Pregnant women with SUI (n=336) will be recruited from a university-affiliated hospital in China. They will be randomly allocated (1:1) to either the intervention group that receive usual care plus UIW app or control group that receive usual care alone. The intervention period will last 2 months. The 5 dimensions of the RE-AIM framework will be evaluated at recruitment (-T1), baseline (T0), immediately after intervention (T1), 42 days after delivery (T2), 3 months after delivery (T3), and 6 months after delivery (T4) through project documents, online questionnaires and a pelvic floor muscle training diary, surface electromyography, log data in the background management system, and qualitative interviews. Data analysis will follow the intention-to-treat principle. Descriptive statistics, t tests, chi-square tests, and a linear mixed model will be used to analyze the quantitative data. Deductive and inductive content analysis will be used to analyze the qualitative data.ResultsThe effectiveness-implementation trial started in June 2020, trial recruitment was completed in October 2020, and the intervention will last for a 2-month period. Completion of the 6-month follow-up will be in July 2021, and we anticipate that the results of this study will be published in December 2021.ConclusionsThis study will evaluate both effectiveness and implementation of the UIW app-based intervention among pregnant women. The hybrid effectiveness-implementation trial design according to the RE-AIM framework with a mixed-methods approach will give valuable insights into the effects as well as facilitators and barriers to the implementation that will influence the effects of the UIW app-based intervention.Trial RegistrationChinese Clinical Trial Registry ChiCTR1800016171; http://www.chictr.org.cn/showproj.aspx?proj=27455International Registered Report Identifier (IRRID)PRR1-10.2196/22771

Transvaginal subfascial synthetic mesh sling in female stress urinary incontinence: A Novel technique

The object of this paper is to assess the treatment outcome and overall efficacy of a novel technique of transvaginal subfascial synthetic mesh for female stress urinary incontinence. The study included 53 patients of female stress urinary incontinence managed at our institution between March 2005 and December 2015. Preoperative evaluation included a detailed history, base-line investigations and cystoscopic examination including stress test, uroflometry with residual urine was done in all cases. Lower urinary tract imaging and urodynamic evaluation was done in selected cases . patients with concomitant pelvic organ prolapse and severe BMI were excluded from the study. All patients underwent a transvaginal subfascial sling procedure under regional anesthesia. Urethral catheter was removed the day after procedure. Post procedure results were assessed in terms of improvement in stress urinary incontinence, procedure related complications, and overall satisfaction of the patient. Mean age of the patients was 43.5 years (25-63 years). All patients were multiparous. Complete resolution of symptoms in 49 patients (92.4%) while in 4 patients (7.5%) had some degree of SUI. Urinary retention in 3 (5.6%), increased frequency in 5 (9.4%) patients and urge incontinence in 2 (3.7%) One (1.8%) had mesh erosion at 3 months after the procedure. None of the patient had any sexual dysfunction on follow up. Overall success rate of the procedure was around 93%.However patients with preoperatively urge incontinence needs anticholinergics in post operative period for 1-2 months. Operative time was 30-45 minutes. Three patients (5.6%) who experience transient postoperative retention had no symptoms of SUI on follow up. Transvaginal subfascial sling is a modification of the original mid urethral sling procedure with an advantage of being less invasive, simpler to learn and achieve similar results compared to other sling procedures.

IS THE FREQUENCY OF CROSSFIT PRACTICE CORRELATED WITH STRESS URINARY INCONTINENCE? A TRANSVERSAL STUDY OF PREVALENCE/ A FREQUÊNCIA DA PRATICA DE CROSSFIT ESTA CORRELACIONADA COM A INCONTINÊNCIA URINARIA DE ESFORÇO? UM ESTUDO TRANSVERSAL DE PREVALÊNCIA

Objective: To verify the prevalence of SUI symptoms in practitioners of high intensity physical activities, such as CrossFit, and to analyze the correlation of the high frequency of this activity with urinary losses, in a CrossFit gym in Greater Florianopolis - SC. Methods: This is a cross-sectional study in which the sample was composed of women who had practiced the CrossFit modality for over a month and over 18 years of age. A questionnaire was applied to assess the data regarding personal characteristics, reproductive life, training frequency and Crossfit time, perceptions about urine loss and evaluation by the Pad-test. Results: The final sample was 34 women, the average age of the participants was 30.3 ± 6.43 years. Among them, 76.4% were nulliparous, 61.7% had been practicing the sport for at least 8 months, 14% reported perceiving urine loss on a daily basis and 88.2% had stress urinary incontinence characterized as mild to moderate. A correlation of greater urinary loss was found the greater the frequency of weekly training Conclusion: Most of the women participating presented urine loss on exertion, classified as mild to moderate. Demonstrating that high intensity activities, such as Crossfit, and their weekly frequency can directly influence stress urinary incontinence. There is a need for further research with a larger sample, greater homogeneity of training and individualization in the evaluation.