Stress Urinary Incontinence Symptoms Research Articles

Prevalence and severity of functional urinary and anorectal disorders and their impact on quality of life in cystic fibrosis

BackgroundIn cystic fibrosis (CF), coughing is associated with a risk of pelvic floor dysfunction. However, data on the prevalence of symptoms (stress urinary incontinence, bladder overactivity, dysuria, and faecal incontinence) are lacking in males and females with CF. The impact of incontinence on adherence to respiratory care has not been studied. MethodsWe conducted a multicentre study in adults with CF followed in the North-West French CF network. Urinary disorders and their severity were assessed using the Urinary Symptom Profile (USP) self-report questionnaire; the impact of urinary disorders on general quality of life was measured using the SF-Qualiveen questionnaire; faecal incontinence was assessed using the Wexner self-report questionnaire; and the CFQ-R14+ questionnaire was used to assess quality of life. A self-administered questionnaire developed for the study assessed the impact of symptoms on respiratory care. ResultsOf the 178 people with CF included, 34 % reported stress urinary incontinence, with a large female predominance (63.5 % of females vs. 7.5 % of males), 65 % bladder overactivity (including 16 % urge incontinence) and 50 % faecal incontinence, also with a female predominance. Neither urinary nor faecal incontinence were related to the severity of the respiratory impairment (FEV1). Quality of life was particularly affected in women. Stress urinary Incontinence symptoms affected respiratory care in both sexes. ConclusionThe prevalence of functional urinary and faecal disorders was high in adults with CF and impacted on quality of life and respiratory care. Therefore, multidisciplinary teams must have knowledge of symptoms, the diagnostic tools and management strategies to provide specific treatment.

The added value of devices to pelvic floor muscle training in radical post-prostatectomy stress urinary incontinence: A systematic review with metanalysis.

To investigate the role of pelvic floor devices (e.g., biofeedback, electrical stimulation, magnetic stimulation, or their combination) as adjunctive treatments in pelvic floor muscle training (PFMT) in stress urinary incontinence (SUI) after radical prostatectomy. A systematic review with meta-analysis. We searched for randomised controlled trials (RCTs) and prospective non-randomised studies investigating the effectiveness of pelvic floor devices as an adjunctive treatment for SUI symptoms assessed with weight pad-test or standardised questionnaires. To assess the risk of bias (RoB) and overall certainty of evidence, the RoB 2.0 or the ROBINS-I, and the GRADE approach were used. Eleven RCTs met our eligibility criteria. One was at a 'low' RoB, one had 'some concerns', while nine were at a 'high' RoB. Two meta-analyses were conducted to analyse the pooled results of six RCTs included. Specifically, two RCTs reported at week 4 with a 1h pad test a mean difference of 0.64 (95% CI = [-13.09, 14.36]), and four RCTs reported at week 12 with a 24h pad test a mean difference of -47.75 (95% CI = [-104.18, 8.69]). The heterogeneity was high in both analyses (I2 = 80.0%; I2 = 80.6%). The overall level of certainty was very low. In line with our results, we cannot conclude whether pelvic floor devices add any value as adjunctive treatment in the management of SUI after radical prostatectomy. Future studies require more comprehensive and standardised approaches to understand whether these devices are effective.

The Effect of Duration of Stress Urinary Incontinence on developing Signs of Bladder Outlet Obstruction in Urodynamic Study

Background: Stress urinary incontinence is a frequent urological disease in women; it has a great influence on an individual’s wellbeing and places a significant economic strain on any health service. The placement of urodynamic diagnostic tests in the evaluation route is an important clinical research concern in this field. Objective: to find out whether the duration of stress urinary incontinence is associated with the finding of bladder outlet obstruction in urodynamic study or not. Subjects and Methods: A descriptive study. With enrolled female patients had symptomatic Stress urinary incontinence as their primary complain. All the included patients were assessed thoroughly by history taking and physical examination and relevant clinical tests and investigation in addition to urodynamic evaluation consisted of multi-channel urodynamics measuring abdominal, vesical and detrusor pressures simultaneously. Results: 140 females were suffering from stress incontinence. Urodynamic study showed maximum urine flow rate (Q max) mean of (20.45±9.86) ml/second, the maximum post void volume was 500ml with 36.89ml was the mean of post void residual volume, and 90.83cm water was the mean of urethral occlusion pressure. The mean of duration have positive relationship with age category but without statically significant. Ninety-eight patients have Q max flow more than 25ml/sec with mean duration 6.04 without any statically significant (p=0.872). 37 patients were having >0 ml post void volume with mean duration more than other patients that didn’t have post void volume but without statically significant (p=0.257). All patients with urethral pressure less than 120 cm had long duration mean than others but without statically significant (p=0.335). also, no statistical significance association between mean of duration and sphincter pelvic floor electromyogram (EMG). Conclusion: there was no catechistically significant relationship between the urodynamic findings and the duration neither of stress urinary incontinence nor between the urodynamic findings and the age of the patients.

Direct abdominal muscle diastasis and stress urinary incontinence in postpartum women.

Currently, there are not enough studies comparing the width of the linea alba in women with and without stress urinary incontinence in postpartum women. The primary aim of the study was to compare the width (IRD) in postpartum women with and without symptoms of stress urinary incontinence (SUI). The secondary aim of the study was to compare pelvic floor muscle morphometry in postpartum women with and without SUI symptoms. IRD distance was measured with a linear probe via 2D US. Urinary leakage symptoms were assessed by the International Consultation on Incontinence Questionnaire (ICIQ - UI SF). Symptoms of overactive bladder were assessed by the Brief Urge Urinary Incontinence Symptoms Questionnaire (OAB-q). The functional status of the pelvic floor muscles was examined by manometry and pelvic floor muscle morphometry was examined by 3D/4D US. We compared IRD distance with and without SUI symptoms in postpartum women. The group of patients with stress urinary incontinence had a greater IRD distance at rest and during exercise compared to women without stress urinary incontinence. No worse pelvic floor muscle function and morphometry was found in women with SUI compared to women without SUI.

Transvaginal Posterior Levatorplasty Combined with Perineoplasty: An Effective Surgical Method for Vaginal Rejuvenation.

Gynecologic cosmetic surgery and rejuvenation surgery have become increasingly popular, with growing demand for vaginal surgery to address vaginal laxity. Follow-up data on the effectiveness of these procedures remain limited. The authors conducted a retrospective study to investigate the effects of transvaginal posterior levatorplasty combined with perineoplasty on vaginal rejuvenation. The study included 45 patients who underwent transvaginal posterior levatorplasty combined with perineoplasty between July of 2020 and May of 2022. Patient characteristics before operation, at baseline, and 3, 6, and 12 months postoperatively, and questionnaires on patient symptoms, quality of life, and sexual function, including the Vaginal Laxity Questionnaire and Female Sexual Function Index, were evaluated. Pelvic ultrasound imaging was performed preoperatively and 3 months postoperatively. Mean vaginal capacity index and vaginal laxity scores were different at baseline and 6 and 12 months postoperatively ( P < 0.01). Female sexual function, including libido, sexual arousal, lubrication, orgasm, sexual satisfaction, and pain levels, were significantly improved (preoperative, 21.68 ± 4.15; 6 months postoperatively, 26.88 ± 2.44; 1 year postoperatively, 29.97 ± 2.10; P < 0.01). Symptoms of stress urinary incontinence and recurrent vaginitis were improved in 78.6% and 90.5% of patients, respectively. On pelvic floor ultrasound, retrovesical angle, urethral rotation angle, levator hiatus, and bladder neck distance were significantly different preoperatively and 3 months postoperatively ( P < 0.01). Overall satisfaction was 93.3% at 12 months postoperatively. Transvaginal posterior levatorplasty combined with perineoplasty is effective for the improvement of patient symptoms, quality of life, sexual function, stress urinary incontinence, and postnatal constipation. Further research on the underlying mechanisms is required. Therapeutic, IV.

Effectiveness of Home-Based Pelvic Floor Muscle Training on Stress Urinary Incontinence and Quality of Life in Multiparous Women

Aim: This study aims to determine the effectiveness of home-based pelvic floor muscle training on decreasing the symptoms of stress urinary incontinence and improving the quality of life among multiparous women Methods: Women who were diagnosed with Stress Urinary Incontinence were invited to take part in this study. These subjects were randomly allocated to either an intervention group or a control group. A 6-week assessment of both groups were carried out for the pelvic floor muscle strength using the modified oxford grading system, for the severity of Incontinence, the ICIQ- short form was used, &amp; for the Quality of Life, Incontinence QoL Scale was used. Results: A total of 60 subjects were included in the study. At the baseline, both the groups were similar in terms of PFM strength, ICIQ score&amp; Incontinence QoL Scale. At the end of 6 weeks of assessment, there was a significant difference (p&lt;0.001) between the control &amp; the intervention group in terms of MOGS, ICIQ score and Incontinence QoL Scale score. Conclusion: The home-based pelvic floor muscle training was found as a safe and effective intervention in decreasing the severity of symptoms and improving the quality of life in multiparous women with SUI.

Patient preferences for stress urinary incontinence treatments: a discrete choice experiment

ObjectivesTo elicit and value patient preferences for the processes and outcomes of surgical management of stress urinary incontinence in women.DesignA discrete choice experiment survey to elicit preferences for type of...

Cost Effectiveness of Concurrent Midurethral Sling at the Time of Prolapse Repair: Results From a Randomized Controlled Trial

ABSTRACT After pelvic reconstructive surgery for pelvic organ prolapse, postoperative stress urinary incontinence (SUI) commonly occurs, which leads many women to choose to have a midurethral sling placed at the time of surgery, even in cases without symptomatic preoperative urinary incontinence. Approximately 27.3% of women with a sling had de novo SUI despite this intervention. Full evaluation of the societal and economic implications brought by a midurethral sling placement attempting to prevent postoperative de novo SUI at the time of a pelvic reconstructive surgery have yet to be evaluated. This study aimed to evaluate the 1-year cost-effectiveness of a midurethral sling in the prevention of SUI at the time of prolapse surgery. This assessment was a randomized controlled trial based on patient resource utilization and patient-reported effectiveness. Study data were obtained via the OPUS randomized clinical trial, which was performed through the Pelvic Floor Disorders Network (a cooperative agreement network sponsored through the National Institute of Child Health and Human Development). A total of 337 women with anterior vaginal prolapse and without SUI symptoms set to undergo treatment from May 2007 to January 2011 were included in the study. Patients were randomly assigned to receive either sham incisions or a midurethral sling during vaginal prolapse surgery. Follow-up occurred at 3, 6, and 12 months postsurgery, with surveys, physical examinations, and medical history. Cost data were collected, and overall health utility in quality-adjusted life-years (QALYs) was calculated. Secondary outcomes were urinary incontinence-specific quality of life and cases of urinary incontinence, as defined by bothersome incontinence symptoms and positive cough stress tests. Initial surgical procedures and subsequent urinary incontinence-related health care were all used for recording health care sector costs. Total costs for study participants were collected via health care resource utilization data, including office visits, additional surgical procedures, and related procedures. The incremental cost-effectiveness ratio was the difference between the sham incision and midurethral sling groups in mean cost, divided by difference in mean QALYs. Data for health care resource utilization were collected during the trial period. Questionnaires at baseline, 3, 6, 9, and 12 months were used to collect other costs. At 1 year, one-way sensitivity analysis was performed for assessing the varying effectiveness of midurethral slings at 1 year, by noting the urinary incontinence-associated patient costs and by using varied QALY for the sling group. Results were taken from a study population of 337 women who underwent randomization to be included in the analysis of cost-effectiveness. No great variance of characteristics existed between groups. One year after surgery, a lower rate of urinary incontinence existed for those in the midurethral sling group. Notably, QALYs were not statistically different between midurethral sling and sham incision groups at baseline, but at 12 months, there was an improvement in both the UDI stress subscale and an overall reduction in the Incontinence Severity Index for the midurethral sling group. In conclusion, although prophylactic midurethral sling placements during vaginal prolapse surgery does reduce the rate of de novo SUI, based on this analysis of date from the OPUS trial, it is not a cost-effective intervention. The decision to place a sling in this setting is often driven by cost savings on the patient side, whereas midurethral sling health care costs are higher than when sling is not done.

(018) Is Female Sexual Dysfunction an Important Factor in Physician Process of Care and Decision-Making for Common Gynecologic Procedures: An Interview Study

Abstract Introduction The mid-urethral sling (MUS) and cervical conization are two common gynecologic procedures performed to correct symptoms of stress urinary incontinence, and to treat cervical dysplasia respectively. There is limited literature surrounding the decision-making process, and process of care physicians follow when performing these procedures. Additionally, current evidence suggests that sexual dysfunction (SD) can result in some women following the MUS procedure and cervical conization, specifically the loop electrosurgical excision procedure (LEEP). Despite this, it is unclear in the literature how physicians performing these procedures perceive this evidence, and if it has an influence on their process of care and decision-making. Objectives The objective of this study was to understand the factors that impact physician decision-making surrounding MUS and cervical conization procedures. A specific interest of this research was determining if and how the recent evidence regarding the potential for post-operative complications of SD is incorporated into the decision-making process and process of care of physicians performing MUS/LEEP. Methods A qualitative semi-structured interview protocol was developed that explored three general areas: pre- and post-operative patient counseling, physicians’ decision making intra-operatively, and physicians’ approach to and perceptions of SD and sexual health counseling. Six Canadian staff physicians with specializations in relevant fields were recruited and interviewed as a pilot study. Thematic content analysis of the recorded and transcribed interviews was completed using NVivo 12. Results All participants indicated a preferred surgical approach (transobturator; LEEP). Factors that influenced this choice included reported risk data, procedure efficacy, and training. A commonly identified theme was the importance of minimizing damage to surrounding tissues (MUS) and minimizing the amount of tissue excised (conization) to mitigate post-operative complications. Most participants acknowledged that these procedures could have a negative impact on female sexual functioning (FSF). However, individual definitions of SD and the perceived type, degree, and potential of impact on these procedures on FSF were highly variable. Most of the participants indicated that they assessed some aspect of their patient’s sexual functioning post-operatively, however none specified a compete assessment of FSF or the use of a validated instrument or questionnaire. None of the MUS physicians reported discussing the evidence-based risk of the possible negative impact of the MUS procedure on orgasm function with their patients. Conclusions The results from this pilot study provide emerging evidence that physicians’ definitions of SD, and the perceived impact of LEEP and MUS on FSF are highly variable and do not fully reflect current evidence. The degree to which the physicians incorporated the reported post-operative risk of SD as a part of their process of care within the context of these procedures was also inconsistent. These results suggest the need for a standardized process of care with regard to counseling patients of the risk of post-operative SD, in addition to the assessment of female sexual health within the context of these two procedures. Further validation of these results is needed in a larger cohort, with an extension of this study that includes American physicians currently underway. Disclosure No.

The effect of e-pelvic floor muscle training on symptoms in women with stress urinary incontinence: a randomized controlled trial

ABSTRACT The aim of this study was to investigate how e-pelvic floor muscle training (e-PFMT) affected urinary incontinence (UI) symptoms and quality of life (QoL) in women with stress urinary incontinence (SUI). Fifty-five women with SUI symptoms were randomly assigned to the intervention (n = 27) or the control (n = 28) group. Both groups were given lifestyle advice about SUI. The intervention group performed e-PFMT three days a week, one day via videoconference, and was supervised by a physiotherapist for eight weeks. UI symptoms were assessed by the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF), the Incontinence Severity Index (ISI), the Urinary Distress Inventory−6 (UDI−6), and QoL was assessed by the King’s Health Questionnaire (KHQ) before and after intervention. After intervention, the Patient Global Impression of Improvement (PGI-I) scale was used to assess improvement, and the Visual Analogue Scale (VAS) was used to assess adherence. While the intervention group’s ICIQ-UI SF, ISI, and UDI−6 scores improved (p < .001), there was no change in the control group (p > .05). Except for personal relationship limitations, all KHQ scores improved in the intervention group. The control group’s role limitations and sleep/energy disturbances scores worsened. ICIQ-UI SF (p = .004), ISI (p < .001), and UDI−6 (p < .001) scores of the intervention group were improved compared to the control group. PGI-I and adherence were found to be higher in the intervention group compared to the control group. e-PFMT performed via videoconference to women with SUI, was found to be effective in improving UI symptoms and QoL as compared to lifestyle instructions only.

Intraurethral ER:YAG laser for stres urinary incontinence

Purpose: To compare the efficacy of concomitant application of intraurethral (IU)+intravaginal (IV) non-ablative Er:YAG laser with IV application in improving the symptoms of stress urinary incontinence (SUI) in women.

(027) Considerations of Mid-Urethral Sling Procedures: Patient and Provider Perspectives on Outcomes and Experiences

Abstract Introduction The mid-urethral sling procedure (MUSP) treats symptoms of stress urinary incontinence. Recent studies have identified the potential for negative outcomes following MUSP; however, there is a limited understanding of the patient and healthcare provider perspectives on procedural experiences and outcomes. Specifically, there is discordance surrounding the role of female periurethral tissue in sexual responses, and limited knowledge of post-MUSP outcomes and symptoms as perceived by patients. Further understanding of current counselling and resource practices is needed, especially regarding informed consent and risk disclosure. Objective To investigate the experiences associated with MUSP from patients who have reported bothersome symptoms following MUSP, and from providers who routinely perform the procedure. Furthermore, to characterize recent patient experiences, explore factors which may influence current provider decision-making, and outline patient-used and provider-recommended counselling and resources. Methods Patients (n=10) who underwent MUSP and reported negative outcomes, and providers (n=22) with experience performing MUSP were recruited. Patients first completed an online survey which captured demographic information, medical history, and sexual function. Both patients and providers completed semi-structured interviews relating to MUSP outcomes and experiences. Interview responses were transcribed using Trint, and qualitative analyses were completed using NVivo 12. Results Perspectives and experiences gathered from patient and provider interviews revealed discordant narrative surrounding MUSP outcomes and treatment. Analysis of patient narratives revealed a unique symptom profile including periurethral pain and numbness, altered lubrication and loss of desire. In addition, patients discussed post-MUSP infections, as well as pain, weakness, and lower limb impairment having impacts on and extending to other aspects of life, including social relationships, work obligations, and day-to-day responsibilities. Patients described a preference for informed pre-procedural care, and supportive and comprehensive post-procedural counselling. Provider narratives revealed aims of fostering open discussions and efforts to offer procedural support. However, providers referenced limitations in time, experience, and understanding of the adverse outcome symptom profile. Further, regarding post-procedural care, both providers and patients discussed limitations in currently available counselling routes and resources. Conclusions The results of this study highlight discordance between the perceptions of patients and providers regarding MUSP outcomes and experiences. There are differences in the understanding of post-MUSP negative outcome experiences as perceived by patients, compared to providers. These findings support the need for improvements in post-MUSP support and targeted counselling, and resources. Differences in the knowledge of symptoms and negative outcome experiences as related to sexual function are emphasized in this context, highlighting, and encouraging the need for improvements in clinical practice which includes sexual health conversations and accessible resources. Disclosure No

(025) Disclosure of Mid-Urethral Sling and Radical Prostatectomy Risks: A Comparative Analysis of Hospital-Affiliated Online Resources

Abstract Introduction Radical prostatectomy (RP) involves the removal of the prostate gland to treat cancer. The mid-urethral sling (MUS) procedure, used to correct symptoms of stress urinary incontinence in women, affects anterior vaginal wall female periurethral tissue (AVW-FPT). Glandular structures in AVW-FPT have similar immunohistochemistry to prostatic tissue. Erectile dysfunction and female orgasmic disorder have been reported following RP and MUS, respectively. The disclosure of these, and other associated risks, in patient education materials has yet to be assessed. Further investigation is required to determine if and how risk information reported in the literature is presented to patients, as it may impact the ability of patients to make informed health-related decisions. Objective To assess the level of knowledge translation to patients of reported risks associated with MUS and RP procedures in hospital affiliated online resources (HAORs) from Canada, Australia, and the United Kingdom, and to evaluate the accessibility of this information using validated measures of health literacy. Methods A list of healthcare institutions in Canada, Australia, and the UK was generated. RP and MUS-specific HAORs were collected from all institutions. Qualitative analysis of 35 HAORs (RP n=20 and MUS n=15) was conducted using NVivo12. The Patient Education Materials Assessment Tool- Print version (PEMAT-P), was used to determine understandability and actionability, and the Flesch-Kincaid Grade Level (FKGL), Gunning Fox Index (GFI), and Simple Measure of Gobbledygook (SMOG) were used to assess the readability. Results Most RP and MUS HAORs were written higher than the recommended grade 5/6 reading level and were below the threshold values for understandability and actionability. The majority of Canadian MUS HAORs met the adequate threshold values for understandability and actionability, unlike the MUS HAORs from Australia and the UK and the RP resources from all three regions. There was inconsistency between the risks reported in the RP and MUS HAORs from Canada and Australia compared to the risks commonly reported in literature. The organization of information including the use of diagrams and medical jargon in the HAORs differed between RP and MUS documents and across the three regions. RP HAORs used diagrams more consistently than MUS HAORs and scored higher on measures of understandability and actionability. The RP and MUS HAORs from the three regions that used medical jargon scored lower on measures of readability. There was inconsistency in the reporting of sexual health risks between the RP and MUS HAORs in all three regions. MUS HAORs less consistently reported sexual health risks following surgery compared to RP HAORs. Conclusions HAORs are important means by which health-related information is translated to patients. There were inconsistencies in the risk information reported for RP versus MUS in Canada, Australia, and the UK. This discordance may impact patient decision-making and health outcomes. The development of guidelines for HAORs curation for healthcare institutions operating under similar healthcare frameworks may be beneficial in ensuring equal access to health information for all patients. Disclosure No

(054) Improvement of Lower Urinary Tract Symptoms by Treating Pelvic Floor Muscle Increased Tone

Abstract Introduction Physical therapy is first line treatment for women diagnosed with urinary incontinence (UI). However, while pelvic floor muscle (PMF) strengthening for decreased PFM tone is well published, there is minimal data evaluating appropriate treatment strategies for PFMs increased tone on the improving of UI. Objective To retrospectively analyze the effectiveness of normalization of PFM tone on lower urinary tract symptoms (LUTS) of women with either stress urinary incontinence (SUI), overactive bladder (OAB), or urgency urinary incontinence (UUI). Methods Medical records of women who received physical therapy care from January 2017 till July 2021 for LUTS and who had increased PFM tone were included in this retrospective, cohort study. Exclusion criteria: previous pelvic surgeries or physiotherapy treatment for PFM dysfunction, neuromuscular diseases, lichen sclerosus et atrophicus, and missing data. Baseline and post-treatment assessments were carried out for: (i) LUTS trough voiding diaries (data on urinary frequency, episodes of SUI, urinary urgency and UUI, nocturia and enuresis) and Questionnaire for Urinary Incontinence Diagnosis (QUID), assessing LUTS with scores from 0-15 (no symptoms to maximum symptomatology); (ii.) PFM tone, via digital palpation using a 7-level grading score (Reissing Scale) from -3 (most decreased) to +3 (most increased PFM tone); (iii.) pain intensity - PFMs active trigger points (TP) were each rated from 0 (no pain) to 10 (worst possible pain) according to the Numerical Rate Scale (NRS); and (iv.) PFM power of contraction (PERFECT scheme). Treatment consisted of in-office physical therapy (including myofascial release, manual stretching of the vaginal walls and perineal massage) twice weekly during six weeks. Self-vaginal stretching and perineal massage was to be done daily by the women over the duration of care. Results Women (n=127) presenting LUTS and increased PFM tone were diagnosed with SUI (35%), OAB (21%), or mixed UI (44%). Mean age was 52 (±13.4). Women presenting normal PFM tone (0) after treatment showed a greater power of PFM contraction when compared to those who maintained tone (≥1) after treatment (2.7±0.9 vs. 2.2±0.6; p=.01; d=0.6) as well as a reduction in SUI episodes (0.1±0.31 vs. 1±1.5; p=.01; d=0.8). Women with improved SUI symptoms at the post-treatment assessment (QUID-SUI score ≤1) compared to those who maintained them (QUID-SUI score &amp;gt;1), had decreased mean of pain intensity (0.88±1.77 vs. 2.59±2.78; p=.002; d=.73) as well as at any given PFM TP according to NRS (0.97±1.92 vs. 2.90± 3.26; p=.002; d=.72). With regard to symptoms of OAB, women who scored ≤1 on the QUID-OAB post-treatment compared to those who scored &amp;gt;1 also showed significant decrease in pain intensity at all trigger points (0.85±1.76 vs. 2.16±2.52; p=.009; d=.60), with maximum pain intensity (0.94±2 .00 vs. 2.42±2.92; p=.010; d=.59), and experienced decreased tone in the right vaginal wall (0.05±0.22 vs. 0.41±0.73; p=.019; d=.67). A mild correlation between increased tone and SUI (p=0.04; r=0.32), episodes of urinary urgency (p=0.02; r=0.37), and nocturia (p=0.007; r=0.43) were shown. Conclusions These study findings points toward to the importance of focusing physiotherapeutic techniques to normalize PFM tone in women with LUTS and increased PFM tone. Disclosure No

SUI in postmenopausal women: advantages of an intraurethral + intravaginal Er:YAG laser

Objective This study aimed to compare the efficacy of concomitant application of an intraurethral (IU) + intravaginal (IV) non-ablative Erbium (Er):YAG laser with IV application in improving the symptoms of stress urinary incontinence (SUI) in women. Methods This observational retrospective cohort study included 122 patients with SUI, 60 women in the IU + IV laser arm and 62 in the IV laser arm. The primary outcome was the International Consultation on Incontinence Questionnaire – Urinary Incontinence Short Form score at entry and at 3, 6 and 12 months from baseline. Results Demographic characteristics were comparable in both arms. Significant improvement in SUI symptoms was seen 3 months after the intervention and was sustained until the end of month 12 in both arms. The women who had severe SUI symptoms initially showed greater improvement. A higher number of women who initially had mild to moderate SUI symptoms were dry after treatment. Patients treated with IU + IV Er:YAG laser showed significant improvement in SUI symptoms compared to IV laser only, especially at postmenopausal state (p = 0.003). Conclusions The Er:YAG laser appears to be an efficient treatment method for SUI. Concomitant application of an IU + IV Er:YAG laser is more effective in relieving SUI symptoms at postmenopausal state.

Predictors of urinary outcomes following robotic-assisted laparoscopic prostatectomy.

Incontinence and urgency are common after prostatectomy. The University of Virginia prostatectomy functional outcomes program (PFOP) was developed to comprehensively assess and optimise continence outcomes following robotic-assisted laparoscopic prostatectomy (RALP). Patients are prospectively evaluated by a Female Pelvic Medicine and Reconstructive Surgery specialist. This study assessed for predictors of 3- and 6-month stress urinary incontinence (SUI) and urgency symptom outcomes following RALP. We performed a post hoc review of patients from our PFOP receiving a minimum of 6-month follow-up. Urinary symptoms are prospectively assessed using the validated International Consultation on Incontinence Questionnaire-Male Lower Urinary Tract Symptoms (ICIQ-MLUTS) questionnaire and daily pad use (pads per day [PPD]). Primary study outcomes included ICIQ-MLUTS SUI and urgency domain scores and PPD. Multivariable linear regression was performed to identify variables associated with outcomes at 3 and 6months postoperatively. Variables included patient, oncologic and surgical factors. Each variable was run in a separate model with pelvic floor muscle therapy and surgeon to reduce confounding and prevent overfitting. Forty men were included. In assessment of ICIQ-MLUTS SUI domain score, at 3months, body mass index (BMI) was associated with worse scores, and at 6months, BMI, hypertension and estimated blood loss (EBL) were associated with worse scores, whereas bilateral nerve-sparing technique was associated with better scores. For ICIQ-MLUTS Urgency domain score, at 3months, preoperative use of benign prostatic hyperplasia (BPH) medication was associated with better scores. No covariates predicted 6-month ICIQ-MLUTS Urgency domain scores. For PPD use, at both 3 and 6months, BMI was a positive predictor, while preoperative use of BPH medication was a negative predictor. Increased BMI, EBL and hypertension are associated with worsened SUI outcomes following RALP, whereas bilateral nerve-sparing technique and preoperative BPH medication are associated with improved SUI outcomes. These data may inform patient counselling and help identify patients who may benefit from closer surveillance and earlier anti-incontinence intervention.

One in four women with stress urinary incontinence who are taught "the knack" maneuver adopt this motor pattern while coughing: A prospective interventional cohort study.

Do women with stress urinary incontinence (SUI) who receive instruction to perform the knack maneuver as part of a 12-week pelvic floor muscle training (PFMT) program perform it during voluntary coughing without specific instruction to do so, and are subjective and objective outcomes better among those who do than among those who do not demonstrate the knack during voluntary coughing? Secondary analysis of a prospective interventional cohort. Women with SUI. 12-week PFMT intervention including instruction to perform the knack. Performance of the knack before a voluntary cough as confirmed through ultrasound imaging. SUI severity determined subjectively (International Consultation on Incontinence Modular Questionnaire-Female Lower Urinary Tract Symptoms[ICIQ-FLUTS] overall score, ICIQ-FLUTS UI subscale score, 3-day bladder diary) and objectively (30-minpad test). Outcome data were available from 69 participants. At baseline, no participants performed the knack when asked to cough. At follow-up, more participants performed the knack during a voluntary cough [18/69 (26%), 95% confidence interval [CI] 15%-35%] than at baseline. The extent of improvement in SUI symptoms was not different between participants who did and did not demonstrate the knack during a voluntary cough [FLUTS-UI subscale score (d = 0.31, 95% CI -0.78 to 2.77, n = 69), FLUTS overall score (d = 0.26, 95% CI -1.52-4.23, n = 69), 30-minpad test (d = 0.03, 95% CI -9.35 to 10.32, n = 69), 3-day bladder diary (d = 0.03, 95% CI -4.07 to 3.60, n = 51)]. Approximately one in four women appear to adopt the knack as a motor response to a cough command, however, adopting the knack was not independently associated with greater improvements in SUI.

Pelvic Floor Muscle Training versus Functional Magnetic Stimulation for Stress Urinary Incontinence in Women: A Randomized Controlled Trial.

There is strong evidence that specific pelvic floor muscle training (PFMT) reduces stress urinary incontinence (SUI), but the application of functional magnetic stimulation (FMS) is still under discussion. To evaluate and compare the effects of FMS and PFMT on pelvic floor muscle function, urinary incontinence symptoms and quality of life (QoL) in women with SUI. A randomized controlled, parallel-group trial was executed in an outpatient physical medicine and rehabilitation centre. The study included 68 women and was fully completed by 48 women (n = 24 in each group) aged 29-49 years, with SUI, who were randomly assigned to PFMT and FMS groups. The symptoms of urinary incontinence and their impact on quality of life were assessed with two questionnaires: the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) and the Incontinence Impact Questionnaire-Short Form (IIQ-7). Perineometer (Pelvexiser) was used to measure the resting vaginal pressure, pelvic floor muscle (PFM) strength and endurance. All outcome measures were taken at baseline and after 6 weeks of interventions. Cohen's effect size (d) was calculated. A significant improvement (p < 0.05) of ICIQ-SF and IIQ-7 was observed in both groups with a high effect size in the PFMT group (d = 1.56 and d = 1.17, respectively) and the FMS group (d = 1.33 and d = 1.45, respectively). ICIQ-SF and IIQ-7 scores did not differ significantly between groups after the 6-week treatment period. Resting vaginal pressure, PFM strength and endurance increased (p < 0.05) in both groups with a medium (d = 0.52) to large (d = 1.56) effect size. No significant difference between groups was found in any measurement of perineometry. PFMT and FMS significantly improved SUI symptoms and the quality of life of the study participants. None of the applied interventions was superior to the other in the short-term effect.

Three-year patient-reported outcomes of single-incision versus transobturator slings for female stress urinary incontinence are equivalent.

Patient-reported outcome measures (PROMs) are important for understanding the success of surgery for stress urinary incontinence, as patient perception of success does not always correlate with physician perception of success. We report PROMS after single-incision slings (SIS) and transobturator mid-urethral slings (TMUS). This was a planned outcome analysis of secondary endpoints in a study in which the primary aim was to compare efficiency and safety using a non-inferiority design (results reported previously). In this analysis of quality of life (QOL), validated PROMs were collected at baseline, 6, 12, 18, 24, and 36 months to quantify incontinence severity (Incontinence Severity Index), symptom bother (Urogenital Distress Inventory), disease-specific QOL impact (Urinary Impact Questionnaire), and generic QOL impact (PGI-I; not applicable at baseline). PROMs were analyzed within treatment groups as well as between groups. Propensity score methods were used to adjust for baseline differences between groups. A total of 281 subjects underwent the study procedure (141 SIS, 140 TMUS). Baseline characteristics were balanced after propensity score stratification. Participants had significant improvement in incontinence severity, disease-specific symptom bother, and QOL impact. Improvements persisted through the study and PROMs were similar between treatment groups in all assessment at 36 months CONCLUSIONS: Following SIS and TMUS, patients with stress urinary incontinence had significant improvement in PROMs including Urogenital Distress Inventory, Incontinence Severity Index, and Urinary Impact Questionnaire at 36 months, indicating disease-specific QOL improvement. Patients have a more positive impression of change in stress urinary incontinence symptoms at each follow-up visit, indicating generic QOL improvement.

Multifaceted therapeutic options for stress urinary incontinence in women

Stress urinary incontinence (SUI) affects many women worldwide in every age group. Involuntary leakage of urine during abdominal pressure increase significantly reduces the quality of life. The choice of treatment depends on the patient's expectations, the doctor's experience and the severity of symptoms. Aim of the study: The aim of this study is to discuss the therapeutic methods of stress urinary incontinence (SUI). Material and method: The work was based on a review of the available literature in the PubMed, Google and Google Scholar databases using the following keywords: stress urinary incontinence; SUI; urinary incontinence in women; Surgical treatment; TOT; TVT. Results and conclusions: We use conservative and surgical methods in the treatment of stress urinary incontinence. Conservative treatments such as physiotherapy, pharmacotherapy, and behavioral therapy are first-line treatments. In the case of severe symptoms of stress urinary incontinence, surgical treatment is used. The most common method is the Burch operation and TVT and TOT sling operations. Treatment of stress urinary incontinence (SUI) in women requires an approach that takes into account the patient's goals, severity of symptoms, desired effect, physician experience and complications, therefore there is no single effective management.