Symptoms Of Stress Incontinence Research Articles

INFLUENCING SYMPTOMS OF URINARY STRESS INCONTINENCE THROUGH PHYSIOTHERAPY

Purpose: Urinary incontinence leads to adverse life changes and psychological stress among patients. The purpose of this report is to follow the effect of implementing a specific exercise program in women with urinary stress incontinence. Material: The study included 30 women who completed a specialized kinesitherapy program over 16 weeks. It included exercises to strengthen the back, abdominal and gluteal muscles, Kegel exercises and balance exercises. Results: A one-hour Pad test was used to monitor the effect of applied kinesitherapy. Results are reported as means with standard deviations with 95% confidence intervals. Conclusions: The obtained results show that specialized exercises have a beneficial effect on the tone of the pelvic floor muscles and reduce the symptoms of urinary stress incontinence.

Integrating Pelvic Floor Muscle Training During Pregnancy in Primary Health Care: A Policy Brief

Women with urinary incontinence (UI) during pregnancy may have a greater of experiencing postpartum UI symptoms than women who do not. Pelvic floor muscle exercises can reduce the symptoms of urinary stress incontinence. This policy brief concisely summarizes research findings and policy recommendations to improve antenatal and postnatal pelvic floor muscle training. However, this policy does not work automatically and must be incorporated in primary health care service design and delivery. This policy brief discusses a clear recommendation based on the best evidence to improve prenatal care services. It argues that the key is high-quality prenatal care that is available, affordable, accessible, and compatible with the needs of pregnant women and health care providers.

Urinary incontinence during pregnancy – of predictive value?

Objective: Primary objective was to find the prevalence of urinary incontinence during pregnancy by its type and see how predicative it was of urinary incontinence in the long term. Associated risk factors were identified as secondary objectives. Method: Antenatal clinics provide opportunistic screening for diseases of the breast, the heart or even the mind. Preventive gynaecological issues could also be addressed likewise. It was felt worth investigating the prevalence of urinary incontinence during pregnancy without undue harassment to the patients by way of a few routinely directed questions about urinary incontinence.This information is rarely volunteered due to embarrassment. 867 women attending antenatal clinics led by the author at teaching hospital Peradeniya, in 2007 and 2008 were interviewed during pregnancy and those incontinent were followed up post-partum at 6 weeks,one and two years till 2010. Patients were inquired regarding the predominant type of incontinence, when the symptoms were mixed(stress and urge both). Results: Of the 867 women analysed, 209 (24%) had some form of urinary incontinence. 110 (52%) of those affected had pure or predominant stress, and 15 (7%) pure or predominantly urge incontinence. The rest 41% had a mixed picture. 154 were still incontinent at 6 weeks post-partum. The proportion of the type of incontinence had changed. 97 (63%) had pure or predominantly stress incontinence, 6 (3.9%) had pure or predominantly urgency and the 33.1% had a mixed picture. 47 of them still complained of some degree of incontinence at the end of one year despite interventions of pelvic floor exercise (PFE),for urodynamic stress incontinence or mixed symptoms. The patterns were even more stress predominant. 33(70%). 2 patients (4.2%) had pure urgency and the rest 12 (25.5%) had a mixed pattern. End of 2 years only 43 patients of those incontinent at 1year were traceable at least over the telephone. Only 23 complained of persistence of the problems. Of the 23 with symptoms at 2 years, 2 were pregnant again. 18 (78%) had pure SI and the rest 5 (22%) had a mixed picture. This indicated that pure stress incontinence tended to persist more than urge incontinence probably indicating some form of permanent damage to the pelvic floor. Older and women of higher parity were found to be more affected again indicating possibility of such injury. Conclusions: The finding that of the initial 209 women who leaked urine during pregnancy 23 remained incontinent at the end of 2 years (11%), is evidence that incontinence during pregnancy is of some predictive value in finding those likely to have long term incontinence.The symptoms of stress incontinence persisted despite PFE. This places doubts on benign physiological and hormonal change theories which is discussed alongside these findings. Incontinence during pregnancy maybe a useful indicator of injury sustained to the pelvic floor providing early warning for trouble ahead with the sphincter mechanism. Questions about urinary incontinence as a routine during antenatal consultations may be a worthwhile exercise. This would take only a very short time and should be encouraged as a higher percentage would have remained incontinent had PFE not been initiated as an ethical intervention.

The impact of preoperative pelvic pain on outcomes after vaginal reconstructive surgery

Pelvic pain is a debilitating condition that is common among women with pelvic floor disorders. Limited information is known about the impact of preoperative pelvic pain on outcomes after vaginal reconstructive surgery. This study aimed to compare the outcomes after vaginal reconstructive surgery between women with and without preoperative pelvic pain. Baseline and postoperative data were analyzed from the "Outcomes Following Vaginal Prolapse Repair and Midurethral Sling trial." The multicenter trial involved women with anterior prolapse without symptoms of stress incontinence randomized to receive either a midurethral sling or sham incisions during a vaginal reconstructive surgery. Participants completed the visual analog scale adapted for suprapubic pain and Pelvic Floor Distress Inventory at baseline, 3 months, and 12 months. Preoperative pelvic pain was defined as a response of "5" or greater on pain on the visual analog scale or answering "moderately" or "quite a bit" on the Pelvic Floor Distress Inventory question, "Do you usually experience pain in the lower abdomen or genital area?" Outcomes and complication rates were compared between women with and without pelvic pain. The "Outcomes Following Vaginal Prolapse Repair and Midurethral Sling trial" participants included 112 women with pelvic pain (58 had a midurethral sling and 54 had sham incisions) and 212 women without pelvic pain (105 had a midurethral sling and 107 had sham incisions). Women who had a midurethral sling and pelvic pain were younger than women without pelvic pain (60.3±12.1 vs 65.1±8.6; P=.004). Women who had sham incisions and pelvic pain were more likely of Hispanic ethnicity than women without pelvic pain (27.8% vs 9.4%; P=.002). Patient improvement based on the Patient Global Impression of Improvement scale did not differ between arms. Women with pelvic pain had greater improvement on the visual analog scale pain scores after a surgical procedure at 3 months (-3.1±2.9 vs-0.4±1.6; P<.001) and at 12 months (-3.4±3.0 vs-0.6±1.6; P<.001) than women without pain, although their pain scores remained higher than those without preoperative pelvic pain at all time points (P<.001 for all). Similar improvements were found on the Pelvic Floor Distress Inventory and Pelvic Floor Impact Questionnaire. The differences observed were not affected by whether women were in the midurethral sling or sham arm of the trial. Postoperative urinary tract infection and incomplete bladder emptying did not differ between the groups. Women with preoperative pelvic pain experienced significant improvements in pain and pelvic floor symptoms with vaginal reconstructive surgery and had similar subjective improvement postoperatively compared with women without preoperative pelvic pain. Reassuringly, the performance of a midurethral sling did not have an impact on the results.

Conservative Management of Urinary Stress Incontinence in Selected Post Menopause Patients with Fractional CO2 Laser

Objective: This PUBA study aims to evaluate the effectiveness of the Fractional CO2 Laser in the conservative treatment of Urinary Stress Incontinence in pre-selected Post-Menopausal Patients, with urine loss to Valsalva maneuvers. Methods: Symptoms of Urinary Stress Incontinence were evaluated before, and 1 month after the last session (3 sessions with a 30-day interval between them) in 50 post-menopausal women (Middle Age - Menopause, Interquartile Range Parity - BMI). Subjective measures (ICIQ SF, VAS) and objective measures such as PAD TEST were used (a dry diaper was previously weighed, and she was instructed to take 500 cc for 15 minutes at rest, and then for 45 minutes to perform Valsalva maneuvers, go up and down stairs, sit, stand up, etc. and then reweigh the diaper) during the study period in order to evaluate the results of the fractional CO2 laser treatment compared to the baseline. Results: Of the 50 patients enrolled, 12 patients in total who presented minimal Urinary symptoms of incontinence (USI) according to the ICIQ questionnaire, all were cured, defining this, as the no loss of urine. Of the 18 patients who presented moderate USI, 10 were cured (55%), that is, they did not present urine loss, and the other 8 patients (45%) had partial recovery, but continued losing urine. Of the 20 patients who presented severe USI, none were cured, 9 (45%) of them remained in severity, and 11 (55%) patients had partial recovery, migrating to the degree of moderate USI. An objective assessment was also performed using the PAD TEST, of the 12 patients with minimal USI, all were cured, of the 18 patients who presented moderate USI, what was found in the ICIQ was confirmed, with 10 patients cured, and 8 with partial recovery. Likewise, of the 20 patients with severe USI, none were cured. VAS (Visual Analogue Scale) was also performed at the end of the treatment and after a year by telephone call, to assess the degree of satisfaction, in regards to the minimal USI at the end of the treatment, this was 100%, and after a year it was reduced to 95%. The patients who presented moderate USI at the end of the treatment presented an average degree of satisfaction of 88.8%, and after 1 year it was 72.2%, and in respect of severe USI it was 6.5% at the end of the laser treatment, and after one year it was 0% Conclusions: In the present study, the data suggest that Fractional CO2 Laser is an effective alternative for the treatment of Minimal-Moderate Urinary Stress Incontinence in well-selected post-menopausal patients, with positive results that persist over time. Keywords (MESH): Fractional CO2 Laser; Menopause; Urinary Incontinence

Trimester-based changes in urogenital symptoms and their impact on the quality of life in pregnant women: A preliminary report

Background:This study is aimed to determine the trimester-based changes in urogenital symptoms and their impact on the quality of life in pregnant women.Materials and methods:Fifty-one pregnant women participated in this study. Self-reported symptom-based questionnaires, Urogenital Distress Inventory-Short Form (UDI-6), Incontinence Severity Index (ISI), and Incontinence Impact Questionnaire (IIQ-7) were administered to determine urogenital symptoms, incontinence severity, and the quality of life in all participants in the first, second, and third trimesters. The findings obtained were analyzed with the Friedman and Spearman tests.Results:Irritative (urgency and frequency) and stress incontinence symptoms showed statistically significant changes (p < 0.05), whereas obstructive and genital pain/discomfort symptoms did not significantly change (p > 0.05) according to the scores of UDI-6 subscales over the trimesters. There were negative, weak-moderate correlations between stress incontinence symptoms and IIQ-7 in the first, second, and third trimester. There was a negative, moderate correlation between irritative symptoms and IIQ-7 only in the third trimester, but there were not any correlations between the other urogenital symptoms and IIQ-7 (p > 0.05). In the prepregnancy period, stress urinary incontinence (SUI) and urge urinary incontinence (UUI) occurred in 9.8% and 7.8% of the patients, respectively, whereas there were no women with mixed urinary incontinence (MUI) preconceptionally. The presence of SUI, UUI, and MUI were 13.7%, 7.8%, and 0% in the first, 26%, 9.8%, and 3.9% in the second, and 41.2%, 27.5%, and 13.7% in the third trimester, respectively. ISI scores showed statistically significant changes in the first, second, and third trimesters of women with SUI, UUI, and MUI (p < 0.05). Statistically significant differences were also found in UDI-6 and IIQ-7 scores obtained from all three trimester evaluations of pregnant women with SUI, UUI, and MUI (p < 0.05).Conclusions:Urogenital symptoms associated with urinary incontinence such as frequency, urgency, and stress incontinence were found to be increased over the course of the three trimesters of the pregnancy and the quality of life was negatively affected. Special care is essential for urinary incontinence during antenatal care.

Psychopathology and Parental Stress in 3-6-Year-Old Children with Incontinence.

Objective: Incontinence and functional gastrointestinal disorders are common in young children and are associated with higher rates of psychological symptoms and mental disorders. This article focuses on the mutual association between incontinence and related toilet refusal syndrome, parental stress, and children's psychopathology especially in young children. Methods: Children's psychological symptoms, mental disorders, and parental stress levels were assessed in 38 parent-child dyads involving children with incontinence and 42 dyads of typically developing (TD) children. Results: Compared to TD children, patients had higher internalizing and externalizing CBCL scores and higher rates of clinically relevant externalizing problems. However, the rates of clinically relevant internalizing problems and mental disorders did not differ. The parents of children with incontinence reported significantly higher stress levels regarding child-related stress factors (PSI-CD) than did parents of TD children. However, there were no clinically relevant parental stress scores on a group level, which remained below the clinical range (T-value < 60). When simultaneously analyzed, children's (comorbid) mental disorders but not incontinence had a major impact on parental stress. Conclusions: Despite moderate stress levels, incontinence symptoms, urinary and fecal incontinence are highly prevalent in young children. However, stress among parents of young children was mainly elicited by any (comorbid) mental disorder.

The Modified Prone Jack-knife Position for the Excision of Female Urethral Diverticula

BackgroundFemale urethral diverticula (UD) are an uncommon and often overlooked aetiology in women presenting with lower urinary tract symptoms, urethral pain, and recurrent urinary tract infection. With increasing awareness, appropriate imaging is more commonly undertaken with consideration given to surgical management. ObjectiveThe video presented demonstrates the technique for excising large and/or complex UD using a modified prone jack-knife position—a position that offers excellent surgical access and allows the surgeon to operate in a more ergonomic position. Design, setting, and participantsA retrospective review of the data on patients undergoing excision of UD at a tertiary referral unit was performed. Surgical procedureUrethral and suprapubic catheters (±insertion of ureteric stents) were placed in supine position. UD excised in the modified prone jack-knife position (±placement of a Martius flap). MeasurementsSubjective cure rate, recurrence rate, rates of postoperative urinary incontinence, need for secondary incontinence procedure, and postoperative complications were measured. Results and limitationsA total of 121 patients were operated on in the study period. The mean follow-up time was 10 mo (range 3–40). The most frequent presenting symptoms included a vaginal mass (n = 76, 63%), followed by dysuria (n = 72, 60%) and pelvic pain (n = 71, 59%). An identifiable aetiological factor was present in 45 patients, including traumatic vaginal delivery (18, 15%), prior periurethral surgery (17, 14%), and urethral dilatation (10, 8%). All patients underwent postvoiding magnetic resonance imaging (MRI) to confirm the diagnosis and plan surgery. UD ranged in maximum diameter from 8 to 48 mm, with a mean of 43 mm (standard deviation 9.24). The most common anatomical location was midurethral (55, 46%), followed by distal (36, 30%), proximal (25, 21%), and full length (5, 4%). Most UDs were single in configuration (74%), followed by multiloculated (15%), saddle shaped (7%), and circumferential (5%). On preoperative videourodynamics, 17 (14%) had stress urinary incontinence. UD excision was undertaken in the modified prone jack-knife position in all cases. A Martius flap was utilised in 36 (30%). The median postoperative postvoiding residual was 26 ml (interquartile range 0–40). In total, 88 (73%) patients were continent postoperatively and 16 (13%) experienced de novo stress urinary incontinence. Of the 37 with pre-existing stress incontinence symptoms, 20 (54%) were continent after operation. A total of 14 patients had subsequent autologous fascial sling at 6 mo. In total, five symptomatic recurrences occurred (4%); of these patients, three elected to undergo surgical excision, all of whom had symptom resolution and were continent after operation. A total of 11 patients (9%) experienced a Clavien-Dindo grade I–II complication within 90 d after operation. Five patients complained of dyspareunia, which resolved by 6 mo. ConclusionsThe modified prone jack-knife position facilitates excellent access for excision of both simple and complex UDs. This positioning of the patient is not widely recognised amongst urologists. Using this approach, there were low rates of symptomatic recurrence and de novo stress incontinence at medium-term follow-up. Associated urinary incontinence resolves in over half of patients following UD excision; hence, we advocate deferring any incontinence procedure until after the results of surgery are established. Patient summarySurgical removal of urethral outpouching (diverticula) in women is challenging due to its potential to damage the nearby sphincter muscle, which controls continence, or the urethra tube. Placement of patients on their front, rather than on their back, provides excellent access for the surgical removal of urethral diverticula. With this approach, we achieved excellent rates of cure and low rates of urinary incontinence at an average follow-up of 10 mo.

Renal Transplantation and Renovascular Hypertension.

dermal estrogen: RR 1.68, 95% CI 1.41, 2.00; oral estrogen with progestin: RR 1.34, 95% CI 1.24, 1.44; transdermal estrogen with progestin: RR 1.46, 95% CI 1.16, 1.84). There was little risk after the cessation of hormones (RR 1.14, 95% CI 1.06, 1.23) and a decreasing risk of incontinence with increasing time since last hormone use; 10 years after stopping hormones, the risk was identical in women who had and had never taken hormone therapy (RR 1.02, 95% CI 0.91, 1.14). CONCLUSION: Postmenopausal hormone therapy appears to increase risk of developing urinary incontinence. This risk does not vary by route of administration, type of hormones, or dose taken, but is diminished upon cessation of use. Editorial Comment: This large study supports the randomized trials which have indicated that hormone therapy does not improve urinary symptoms. In fact,there was a significant increase in the risk of developing incontinence over 4 years in those taking postmenopausal hormone therapy at baseline,and this risk was similar for users of estrogen alone and estrogen combined with progestin,as well as users of oral or transdermal estrogen. The elevated risk was evident for short-term and long-term users but decreased after cessation of hormone therapy. Symptoms of stress and urge incontinence were not separated,however—a shortcoming of the study,as it is certainly possible that one type could be affected and not the other,and it is even possible that one type could be benefited. The authors acknowledge this in their discussion,and also the fact that (1) all information on hormone therapy and incontinence is self-reported,and (2) in an observational study it is possible that results are due to confounding but they point out that this potential is reduced because health professionals in this subject all had good access to health care and sound health knowledge regardless of their hormone use.

Long-term patient-reported outcomes after laparoscopic Burch colposuspension.

The negative media attention surrounding vaginal mesh procedures has seen a rise in demand for minimally invasive non-mesh options for the treatment of stress urinary incontinence (SUI). The laparoscopic Burch colposuspension (LBC) is a non-mesh alternative to synthetic midurethral slings (MUS) with similar short-term outcomes. However, long-term outcomes are not well established. To evaluate the long-term outcomes of LBC for treatment of SUI in women. One hundred and fifty-one cases of LBC were performed by a single surgeon over two private hospital settings between January 2010 and January 2016. Follow-up subjective outcomes were obtained in 137 cases (90.7%) utilising standardised questionnaires. Primary outcome was successful treatment of SUI, defined as subjective cure or significant improvement of stress incontinence symptoms. Secondary outcomes included new-onset or worsened symptoms of overactive bladder (OAB), voiding dysfunction, prolapse, and perioperative complications. One hundred and thirty-seven patients were analysed with a mean follow-up of 50.6months (range: 13-89months). Primary outcome of successful treatment was achieved in 90.5% of women. New-onset or worsened symptoms of OAB was reported in 10.2%, with a further 8.8% of women experiencing symptomatic voiding dysfunction. Sixteen patients (11.7%) reported new-onset or worsening symptoms of prolapse. There were no major surgical complications. LBC is a safe and effective long-term treatment for SUI, with low failure rates and minimal adverse outcomes. It is a suitable alternative for women with contraindications to mesh or those having concomitant laparoscopic procedures.

Patient Characteristics that May Influence the Effect of Urethral Injection Therapy for Female Stress Urinary Incontinence.

Urethral injection therapy is a well-known treatment of female stress urinary incontinence but to our knowledge the optimal group of recipients has not been established. In this study we examined which patient characteristics are associated with success after urethral injection therapy. This study is a post hoc analysis of a previously published, randomized, 33-center study of the hydrogel bulking agent Bulkamid® vs the collagen gel Contigen®. Regardless of the treatment women were considered cured if there were no stress incontinence episodes in the bladder diary and no stress incontinence symptoms on the ICIQ-UI-SF (International Consultation on Incontinence Questionnaire-Urinary Incontinence-Short Form), improved if there was a 50% or greater reduction in stress incontinence episodes and no effect if there was less than a 50% reduction in stress incontinence episodes 1 year after treatment. Of the 345 women who were initially randomized 291 were included in this study. A total of 191 women received hydrogel and 100 received collagen. At 1 year 74 women (25%) were cured, 164 (56%) were improved and 53 (18%) showed no effect. On multivariate logistic regression analysis age 60 years or greater and fewer than 2.5 daily stress incontinence episodes were associated with cure. In this group 90% of women experienced a treatment effect and 38% were cured compared with a 13% cure rate in those younger than 60 years with 2.5 or more daily stress incontinence episodes. Urethral injection therapy was more effective to treat stress urinary incontinence in women 60 years old or older with fewer than 2.5 daily stress incontinence episodes. It had a 90% success rate in these women.

PREVALENCE OF UROGYNECOLOGY SYMPTOMS IN A RURAL POPULATION IN WESTERN-UGANDA

Objectives The primary objective of our study was to determine the prevalence of pelvic floor dysfunction (PFD) in women from rural, Western Uganda. A long term goal would be to encourage the development of training programs for specialists that care for women's pelvic floor concerns, especially those that stem from childbirth or the long-term effects of multiple pregnancies. Methods The study design was a population based cross-sectional survey. The survey administered was the UDI-6 (Urinary Distress inventory-6) with the addition of 2 questions related to obstetrical fistula. 271 women completed the survey during a 5-day medical camp in rural-western Uganda in February 2017. Demographic data was also taken including age, gravida, parity, age at first birth, hysterectomy, completion of high school and menopausal status. Results Thirty-nine percent of women suffered from prolapse symptoms while 30% and 27% complained of stress and urge incontinence symptoms, respectively. Twenty percent of our participants knew 1-2 women suffering from fistula, with 37% citing fistula as a devastating problem in their region. Conclusions Issues of female pelvic medicine are prevalent in rural Uganda and require more education and surgical expertise to be directed towards this area of women's health, especially on a local level. This survey study is helpful in gauging the need for further training in the area of PFD in the form of post-graduate fellowship programs.

Impact of Action II Petite Lady Laser Machine in the Treatment of Urinary Incontinence and Sexual Dysfunction in Female

Background and Aims: Urinary incontinence &amp; sexual Dysfunction is very common among female. It causes social or hygienic problem. Urinary incontinence is the uncontrolled leakage of urine. This condition affects about a third of the female population and is more common in women than in men5. Recently the Action II Petite Lady laser has attracted attention for urinary incontinence and sexual dysfunction as non-invasive way that is aimed at awakening a woman’s sensuality by tightening up their vaginal canal. The current study evaluated the clinical efficacy of the Action II Petite lady laser on the treatment of sexual dysfunction and urinary incontinence in females. Subjects and Methods: Thirty woman with Urinary incontinence &amp; sexual Dysfunction, ages from 25 – 55 year were treated for four sessions two weeks apart between the first three sessions and one month apart between the third and fourth session with a 2940 nm Er: YAG via 90° and 360 scanning scopes. PFX2 assessments were performed at baseline, one –month post treatment and at 2 months’ post-treatment for vaginal muscle power. FSFI questionnaires were answered pre-post intervention, and bladder diaries were used. Subjective satisfaction was assessed about sexual satisfaction. Results: All subjects successfully completed the study with no adverse events. Significant improvement in vaginal muscle power was seen in all subjects at 2 months’ post-procedure based on the PFX2 values, sexual satisfaction as assessed by the subjects themselves 57.7% very satisfied and 42.3% moderately satisfied. The comparison between the means of the considered parameters before and after the treatment showed a very significant difference in reducing the symptoms of stress incontinence. Conclusions: Er: YAG laser treatment for urinary incontinence and sexual dysfunction produced significant improvement. With multicast delivered in the multiple micro pulse modes via 90 and 360scanning scopes, nonsurgical Er: YAG laser treatment was pain-free, safe, side effect free, easily tolerated and effective.

Urinary incontinence among women-which personal and professional relations are involved? A population-based study.

Urinary incontinence (UI) is frequent among women worldwide, but embarrassment and shame can prevent them from discussing symptoms with others. This study aimed to identify personal and professional relations involved by Danish women with UI. It further aimed to investigate whether age, persistence of symptoms, number of symptoms, influence on daily activities and concern about the symptoms are associated with involving personal and professional relations. A sample of 51,090 Danish women, aged ≥ 20years, were invited to participate in a web-based cross-sectional survey in 2012. We identified individuals with self-reported symptoms of stress incontinence, urge incontinence and UI without stress/urge and explored the involvement of personal and professional relations. Descriptive statistics and multivariate logistic regression were used for analyses. In total, 26,466 women completed the questionnaire. Of the 5861 (22.1%) women who had experienced a minimum of one UI symptom within the preceding 4weeks, 71.4% did not involve any professional relations and 45.0% did not involve any personal relations. Further, 38.8% involved neither personal nor professional relations. Personal relations were most often involved, mainly those with the spouse/partner, friends and children. Involving a personal relation was associated with three to five times increased odds of involving health care professionals for all UI types. UI is highly prevalent, but the condition is infrequently discussed in personal and professional relations. Future research should address the quality of the contacts made and barriers to involving other people.

Urinary Incontinence and Overactive Bladder Syndrome

Urinary incontinence falls into two broad categories: stress incontinence and urge incontinence. Stress urinary incontinence occurs when urethral closure pressure cannot increase sufficiently to compensate for a sudden increase in intra-abdominal pressure, as from a cough or Valsalva maneuver. Urge urinary incontinence occurs when an unintended bladder contraction creates an insuppressible urge to void, leading to urinary leakage. When women have signs and/or symptoms of both stress and urge incontinence, it is referred to as mixed urinary incontinence. Overactive bladder syndrome is defined by the Standardization Subcommittee of the International Continence Society (ICS) as urinary urgency, with or without urge incontinence and usually with frequency and nocturia. Nocturia, which is often associated with urinary frequency, is defined as a need to urinate that awakens the person during the night. This chapter discusses the epidemiology and physiology of urinary incontinence and overactive bladder syndrome in women, as well as diagnosis and treatment. Tables list foods and beverages that may cause urinary frequency and urgency; features of urge incontinence, stress incontinence, and mixed incontinence; American Urologic Association (AUA) guidelines regarding level of evidence and indications for adult urodynamics; and currently available antimuscarinic drugs and their dosages, selectivity, efficacy, and side effects. Figures depict the journal of someone with mixed incontinence, a typical urodynamics suite, a urodynamic study of someone with detrusor overactivity, incontinence pessaries, and transobturator and retropubic slings. This review contains 5 figures, 5 tables, and 44 references.

Stress Urinary Incontinence Management in the Patient With Overactive Bladder

Mixed urinary incontinence is a common diagnosis that has significant impact on patient quality of life and can be more bothersome to patients compared to pure stress incontinence. Given the complexity of concomitant stress incontinence and overactive bladder symptoms, mixed urinary incontinence can often present as a clinically challenging scenario for treating physicians across different subspecialties and primary care medicine. In this review, we discuss the importance of a judicious evaluation and the utility of deciphering stress-predominant versus urge-predominant urinary incontinence in patients with concomitant symptoms. The temporal relationship between stress incontinence and urgency symptoms has been explored in recent literature. Although a common pathway has been alluded, characterization of the predominant symptom is essential in treating this difficult diagnosis. As suggested in recent guidelines, emphasis should be placed on setting appropriate patient goals of care and discussing treatment expectations in order to best optimize patient satisfaction and patient-reported treatment success. Risks, benefits, and alternatives for both stress urinary incontinence and overactive bladder treatment options should be reviewed, yet there is lack of a standardized approach in the literature. We outline a sequential algorithm to help guide patient counseling, management, and appropriate expectations for treatment of mixed urinary incontinence.

Urinary Incontinence and Overactive Bladder Syndrome

Urinary incontinence falls into two broad categories: stress incontinence and urge incontinence. Stress urinary incontinence occurs when urethral closure pressure cannot increase sufficiently to compensate for a sudden increase in intra-abdominal pressure, as from a cough or Valsalva maneuver. Urge urinary incontinence occurs when an unintended bladder contraction creates an insuppressible urge to void, leading to urinary leakage. When women have signs and/or symptoms of both stress and urge incontinence, it is referred to as mixed urinary incontinence. Overactive bladder syndrome is defined by the Standardization Subcommittee of the International Continence Society (ICS) as urinary urgency, with or without urge incontinence and usually with frequency and nocturia. Nocturia, which is often associated with urinary frequency, is defined as a need to urinate that awakens the person during the night. This chapter discusses the epidemiology and physiology of urinary incontinence and overactive bladder syndrome in women, as well as diagnosis and treatment. Tables list foods and beverages that may cause urinary frequency and urgency; features of urge incontinence, stress incontinence, and mixed incontinence; American Urologic Association (AUA) guidelines regarding level of evidence and indications for adult urodynamics; and currently available antimuscarinic drugs and their dosages, selectivity, efficacy, and side effects. Figures depict the journal of someone with mixed incontinence, a typical urodynamics suite, a urodynamic study of someone with detrusor overactivity, incontinence pessaries, and transobturator and retropubic slings. This review contains 5 figures, 5 tables, and 44 references.

Urinary Incontinence and Overactive Bladder Syndrome

Urinary incontinence falls into two broad categories: stress incontinence and urge incontinence. Stress urinary incontinence occurs when urethral closure pressure cannot increase sufficiently to compensate for a sudden increase in intra-abdominal pressure, as from a cough or Valsalva maneuver. Urge urinary incontinence occurs when an unintended bladder contraction creates an insuppressible urge to void, leading to urinary leakage. When women have signs and/or symptoms of both stress and urge incontinence, it is referred to as mixed urinary incontinence. Overactive bladder syndrome is defined by the Standardization Subcommittee of the International Continence Society (ICS) as urinary urgency, with or without urge incontinence and usually with frequency and nocturia. Nocturia, which is often associated with urinary frequency, is defined as a need to urinate that awakens the person during the night. This chapter discusses the epidemiology and physiology of urinary incontinence and overactive bladder syndrome in women, as well as diagnosis and treatment. Tables list foods and beverages that may cause urinary frequency and urgency; features of urge incontinence, stress incontinence, and mixed incontinence; American Urologic Association (AUA) guidelines regarding level of evidence and indications for adult urodynamics; and currently available antimuscarinic drugs and their dosages, selectivity, efficacy, and side effects. Figures depict the journal of someone with mixed incontinence, a typical urodynamics suite, a urodynamic study of someone with detrusor overactivity, incontinence pessaries, and transobturator and retropubic slings. This review contains 5 figures, 5 tables, and 44 references.

The role of macroplastique implantation in the management of occult urinary stress incontinence

ObjectivePelvic floor disorders, in particular pelvic organ prolapse (POP) and stress urinary incontinence (SUI), are common in women.There is a described higher risk to develop postoperative SUI also in preoperatively continent women: this happens because in 30% of women the relief of the urethral obstruction caused by prolapse, unmasks a pre-existing compromised urethral function and thus an “occult” or potential SUI. The aims of this study were to evaluate the role of Macroplastique® implant, TVT-O or surgery alone in the management of occult urinary stress incontinence during prolapse surgery in terms of success rate and adverse events. Study designWe enrolled 47 consecutive patients scheduled to vaginal prolapse surgery who did not report symptoms of stress incontinence. We collected surgical data, success and complication rates. Moreover we compared all the data with retrospective ones regarding surgery plus concomitant TVT-O (39 pts) and surgery alone (41 pts). ResultsAt 12-months follow-up, we reported a success rate of 87,2% in the “macroplastique group”, comparable to the “surgery plus TVT-O group”, with a statistically significant difference in comparison to the “surgery alone” group. “Surgery + TVT-O” group reported a higher rate of major complications (p<0,01) in comparison to the other groups. ConclusionsPostoperative SUI prevention at the time of prolapse repair remains a challenging issue. In selected patients, Macroplastique may play an interesting role having a good success rate and a low complication rate and for these reasons it may be proposed as A concomitant procedure during POP surgery.

Lower urinary tract symptoms that predict microscopic pyuria

Introduction and hypothesisUrinary dipsticks and culture analyses of a mid-stream urine specimen (MSU) at 105 cfu ml−1 of a known urinary pathogen are considered the gold standard investigations for diagnosing urinary tract infection (UTI). However, the reliability of these tests has been much criticised and they may mislead. It is now widely accepted that pyuria (≥1 WBC μl−1) detected by microscopy of a fresh unspun, unstained specimen of urine is the best biological indicator of UTI available. We aimed to scrutinise the greater potential of symptoms analysis in detecting pyuria and UTI.MethodsLower urinary tract symptom (LUTS) descriptions were collected from patients with chronic lower urinary tract symptoms referred to a tertiary referral unit. The symptoms informed a 39-question inventory, grouped into storage, voiding, stress incontinence and pain symptoms. All questions sought a binary yes or no response. A bespoke software package was developed to collect the data. The study was powered to a sample of at least 1,990 patients, with sufficient power to analyse 39 symptoms in a linear model with an effect size of Cohen’s f2 = 0.02, type 1 error probability = 0.05; and power (1-β); 95% where β is the probability of type 2 error). The inventory was administered to 2,050 female patients between August 2004 and November 2011. The data were collated and the following properties assessed: internal consistency, test–retest reliability, inter-observer reliability, internal responsiveness, external responsiveness, construct validity analysis and a comparison with the International Consultation on Incontinence Modular Questionnaire for female lower urinary tract symptoms (ICIQ-FLUTS). The dependent variable used as a surrogate marker of UTI was microscopic pyuria. An MSU sample was sent for routine culture.ResultsThe symptoms proved reliable predictors of microscopic pyuria. In particular, voiding symptoms correlated well with microscopic pyuria (χ2 = 88, df = 1, p < 0.001). The symptom inventory has significant psychometric characteristics as below: test–retest reliability: Cronbach’s alpha was 0.981; inter-observer reliability, Cronbach’s alpha was 0.995, internal responsiveness F = 221, p < 0.001, external responsiveness F = 359, df = 5, p < 0.001. The correlation coefficients for the domains of the ICIQ-FLUTS were around R = 0.5, p < 0.001.ConclusionThis symptoms score performed well on the standard, psychometric validation. The score changed in response to treatment and in a direction appropriate to the changes in microscopic pyuria. It correlated with measures of quality of life. It would seem to make a good candidate for monitoring treatment progress in ordinary clinical practice.