Treatment Of Urge Urinary Incontinence Research Articles

Urgency urinary incontinence and the interoceptive network: a functional magnetic resonance imaging study

Treatment of urgency urinary incontinence has focused on pharmacologically treating detrusor overactivity. Recent recognition that altered perception of internal stimuli (interoception) plays arole in urgency urinary incontinence suggests that exploration of abnormalities of brain function in this disorder could lead to better understanding of urgency incontinence and its treatment. We sought to: (1) evaluate the relationship between bladder filling, perceived urgency, and activation at brain sites within theinteroceptive network in urgency urinary incontinence; (2) identify coactivation of other brain networks that could affect interoception during bladder filling in urgency incontinence; and (3) demonstrate interaction between these sites prior to bladder filling by evaluating their resting-state connectivity. We performed an observational cohort study using functional magnetic resonance imaging to compare brain function in 53 women with urgency urinary incontinence and 20 controls. Whole-brain voxelwise analyses of covariance were performed to examine differences in functional brain activation between groups during a task consisting of bladder filling, hold (static volume), and withdrawal phases. The task was performed at 3 previously established levels of baseline bladder volume, the highest exceeding strong desire to void volume. All women continuously rated their urge on a 0- to 10-point Likert scale throughout the task and a mixed measures analysis of variance was used to test for differences in urge ratings. Empirically derived regions of interest from analysis of activation during the task were used as seeds for examining group differences in resting-state functional connectivity. In both urgency urinary incontinent participants and controls, changes in urge ratings were greatest during bladder filling initiated from a high baseline bladder volume and urgency incontinent participants' rating changes were greater than controls. During this bladder-filling phase urgency incontinent participant's activation of the interoceptive network was greater than controls, including in the left insula and the anterior andmiddle cingulate cortex. Urgency incontinent participant's activation was also greater than controls at sites in the ventral attention network and posterior default mode network. Urgency incontinent participant's connectivity was greater than controls between a middle cingulate seed point and the dorsal attention network, a "top-down" attentional network. Control connectivity was greater between the midcingulate seed point and the ventral attention network, a "bottom-up" attentional network. Increasing urge was associated with greater urgency incontinent participant than control activation of the interoceptive network and activation in networks that are determinants of self-awareness (default mode network) and of response to unexpected external stimuli (ventral attention network). Differences in connectivity between interoceptive networks and opposing attentional networks (ventral attention network vsdorsal attention network) were present even before bladder filling (in the resting state). These findings are strong evidence for a central nervous system component of urgency urinary incontinence that could be mediated by brain-directed therapies.

PD36-03 URGE 1 STUDY - RANDOMIZED CLINICAL TRIAL TO COMPARE SOLIFENACIN AND BILATERAL MESH REPLACEMENT OF THE UTEROSACRAL LIGAMENTS IN THE TREATMENT OF URGENCY URINARY INCONTINENCE IN WOMEN

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Female Incontinence: Therapy I1 Apr 2016PD36-03 URGE 1 STUDY - RANDOMIZED CLINICAL TRIAL TO COMPARE SOLIFENACIN AND BILATERAL MESH REPLACEMENT OF THE UTEROSACRAL LIGAMENTS IN THE TREATMENT OF URGENCY URINARY INCONTINENCE IN WOMEN Sebastian Ludwig, Martin Stumm, Peter Mallmann, and Wolfram Jager Sebastian LudwigSebastian Ludwig More articles by this author , Martin StummMartin Stumm More articles by this author , Peter MallmannPeter Mallmann More articles by this author , and Wolfram JagerWolfram Jager More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1108AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Standard treatments of urgency urinary incontinence (UUI) are based on the hypothesis that UUI is a neurological disorder. According to Petros and Ulmstens′ Integral Theory UUI is caused by defective uterosacral ligaments (USL). We introduced a bilateral mesh augmentation of the USL: the cervico-sacropexy (CESA) or vagino-sacropexy (VASA). In order to evaluate these two different hypotheses we compared the standard pharmacological treatment with the surgical approach of CESA or VASA in the treatment of UUI in women. Comparison of therapeutic efficacy between solifenacin and CESA or VASA surgeries in women with urgency urinary incontinence symptoms. METHODS Women with UUI symptoms and without previous treatment were eligible for this study (ClinicalTrails.gov Identifier: NCT01737411). UUI symptoms were assessed according to validated questionnaires. Urodynamics were performed before and after each treatment arm. Patients were randomized either in the pharmacological therapy arm (10mg solifenacin for 4 months) or in the surgical procedure arm (CESA or VASA). After 4 months the efficacy of each treatment arm was assessed by incontinence questionnaires. The non-responders were crossed-over. Polyvinylidene fluoride (PVDF) tapes of identical length were used for open abdominal USL augmentation and named cervico-sacropexy (CESA) or vagino-sacropexy (VASA) depending on the site of fixation (sacrum/cervix or sacrum/vagina). These tapes were sutured either on the cervix or vaginal stump and placed under the left and right peritoneal fold of the USL to the sacrum and attached to the pre-sacral fascia in front of the S1/S2 sacral vertebra. RESULTS After primary solifenacin 2 out of 37 patients (5%) were temporary cured. After primary CESA or VASA 16 out of 40 patients (40%) were cured. After cross-over 1 patient was cured after solifenacin and 10 out of 25 patients (40%) were cured after CESA or VASA. CONCLUSIONS In total, only 3 out of 58 patients (5%) with UUI symptoms responded to solifenacin. In contrast, after CESA or VASA 26 out of 65 patients (40%) were cured of their UUI symptoms. The CESA and VASA surgical procedures provide a causal therapy in the treatment of UUI. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e850 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Sebastian Ludwig More articles by this author Martin Stumm More articles by this author Peter Mallmann More articles by this author Wolfram Jager More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Surgical Treatment of Urgency Urinary Incontinence, OAB (Wet), Mixed Urinary Incontinence, and Total Incontinence by Cervicosacropexy or Vaginosacropexy

We previously developed a standardized surgical method to replace the uterosacral-ligaments in patients with genital prolapse. These cervicosacropexy (CESA) or vaginosacropexy (VASA) operations were effective in treating genital prolapse and urinary incontinence. In this study, we investigated the effects of these operations in combination with a transobturator tape (TOT) 8/4 procedure for the treatment of urgency urinary incontinence (UUI), overactive bladder (OAB), mixed urinary incontinence (MUI), and total incontinence (TI) in patients without symptomatic prolapse. Material and Methods: Patients with UUI, OAB, MUI, and TI were eligible for the study and an informed consent was obtained. Patients with genital prolapse POP-Q stage>I were excluded. The USLs in all the patients were replaced by standardized polyvinylidene fluoride structures by CESA/VASA. If patients remained incontinent, they received a TOT 8/4. Main outcome analysis was performed 4 months after the previous surgery. Data were analyzed retrospectively. Results: 133 patients were operated by CESA (n=57) or VASA (n=76). Subsequently, continence was reestablished in 57 patients (43%). The respective continence rates ranged from 27% (CI [5-49%]) in patients with TI to 73% (CI [54-92%]) in patients with UUI. After 75 patients received an additional TOT 8/4, the overall continence rates were 33% and 86% for patients with TI and those with UUI, respectively. Conclusion: The results of this study strongly support the hypothesis that urinary continence is based on the anatomical changes of the different levels of the holding apparatus of the bladder. The bilateral suspension of level I by CESA/VASA cured 66%-72% of the patients with UUI and OAB. In patients with MUI, an additional repair of level III by a TOT 8/4 was necessary to achieve a cure rate of 76%. Only patients with TI demonstrated a success rate of 33% after the suspension of the levels I and III indicating an additional problem of level II.

The female urinary microbiome in urgency urinary incontinence

The purpose of this study was to characterize the urinary microbiota in women who are planning treatment for urgency urinary incontinence and to describe clinical associations with urinary symptoms, urinary tract infection, and treatment outcomes. Catheterized urine samples were collected from multisite randomized trial participants who had no clinical evidence of urinary tract infection; 16S ribosomal RNA gene sequencing was used to dichotomize participants as either DNA sequence-positive or sequence-negative. Associations with demographics, urinary symptoms, urinary tract infection risk, and treatment outcomes were determined. In sequence-positive samples, microbiotas were characterized on the basis of their dominant microorganisms. More than one-half (51.1%; 93/182) of the participants' urine samples were sequence-positive. Sequence-positive participants were younger (55.8 vs 61.3 years old; P = .0007), had a higher body mass index (33.7 vs 30.1 kg/m(2); P = .0009), had a higher mean baseline daily urgency urinary incontinence episodes (5.7 vs 4.2 episodes; P < .0001), responded better to treatment (decrease in urgency urinary incontinence episodes, -4.4 vs -3.3; P = .0013), and were less likely to experience urinary tract infection (9% vs 27%; P = .0011). In sequence-positive samples, 8 major bacterial clusters were identified; 7 clusters were dominated not only by a single genus, most commonly Lactobacillus (45%) or Gardnerella (17%), but also by other taxa (25%). The remaining cluster had no dominant genus (13%). DNA sequencing confirmed urinary bacterial DNA in many women with urgency urinary incontinence who had no signs of infection. Sequence status was associated with baseline urgency urinary incontinence episodes, treatment response, and posttreatment urinary tract infection risk.

Are we shortchanging frail older people when it comes to the pharmacological treatment of urgency urinary incontinence?

Overactive bladder and urgency incontinence are common and distressing conditions in older people, for which the first-line pharmacological treatment is a bladder antimuscarinic agent. Of these, oxybutynin is often recommended in guidelines, but is associated with a higher incidence of adverse drug effects, and in particular has been suggested to have deleterious cognitive effects. Despite this, guidelines often suggest oxybutynin as first-line treatment, and insurance based healthcare systems often require oxybutynin to be used as a first-line therapy and fail before reimbursement for the cost of newer anticholinergics is authorised. We reviewed the literature of bladder antimuscarinics in older adults, using the headings overactive bladder, urinary frequency, urgency, urge, oxybutynin, antimuscarinic, older, older people, and frail. In general, oxybutynin had a similar efficacy to other anticholinergic drugs, but a higher incidence of adverse drug events, in particular significant yet unnoticed cognitive impairment. We conclude that oxybutynin should not be used in frail older people.

Protocolo diagnóstico y terapéutico de la incontinencia y del síndrome vesical irritativo

Urinary problems, especially urinary incontinence, overactive bladder and benign prostatic hyperplasia, are a quite common and specific group of pathological disorders of the lower urinary tract on the older population, that cause a significant impairment on the quality of life. A multidimensional assessment, as well as the clinical and quality of life impacts, of the older people with these problems is required, due to their multifactorial origin. The clinical and quality of life questionnaires constitute a very important tool in the initial assessment and also in the follow-up and in the evaluation of the treatment's response. The medical management of these problems is very wide and varied, underlying the conservative therapies (hygienic and medical recommendations plus changes in the life style) as well as the drugs, especially the antimuscarinic drugs in the treatment of urge urinary incontinence and overactive bladder, together with the alpha-blockers and the inhibitors of 5 alpha-reductase in benign prostatic hyperplasia.

The female urinary microbiome: a comparison of women with and without urgency urinary incontinence.

ABSTRACTBacterial DNA and live bacteria have been detected in human urine in the absence of clinical infection, challenging the prevailing dogma that urine is normally sterile. Urgency urinary incontinence (UUI) is a poorly understood urinary condition characterized by symptoms that overlap urinary infection, including urinary urgency and increased frequency with urinary incontinence. The recent discovery of the urinary microbiome warrants investigation into whether bacteria contribute to UUI. In this study, we used 16S rRNA gene sequencing to classify bacterial DNA and expanded quantitative urine culture (EQUC) techniques to isolate live bacteria in urine collected by using a transurethral catheter from women with UUI and, in comparison, a cohort without UUI. For these cohorts, we demonstrated that the UUI and non-UUI urinary microbiomes differ by group based on both sequence and culture evidences. Compared to the non-UUI microbiome, sequencing experiments revealed that the UUI microbiome was composed of increased Gardnerella and decreased Lactobacillus. Nine genera (Actinobaculum, Actinomyces, Aerococcus, Arthrobacter, Corynebacterium, Gardnerella, Oligella, Staphylococcus, and Streptococcus) were more frequently cultured from the UUI cohort. Although Lactobacillus was isolated from both cohorts, distinctions existed at the species level, with Lactobacillus gasseri detected more frequently in the UUI cohort and Lactobacillus crispatus most frequently detected in controls. Combined, these data suggest that potentially important differences exist in the urinary microbiomes of women with and without UUI, which have strong implications in prevention, diagnosis, or treatment of UUI.

Long-term Efficacy and Safety of Questionnaire-Based Initiation of Urgency Urinary Incontinence Treatment

ABSTRACTA large number of women with urinary incontinence do not receive appropriate care because of delays in diagnosis resulting from failure of primary care providers to ask routine questions about incontinence as well as failure of patients to volunteer information. Diagnosis of incontinence onl

Editorial Comment

Mental and emotional stress induced by external or internal stressors, or both, can exert biological effects. Some stress, such as when it is a temporary and acute reaction danger or a problem, is positive. Biological effects in this scenario would enhance one's ability to handle or avert the stressor. Continuous or chronic stress, however, is a negative reaction that may contribute variably and adversely to health. Chronic stress in susceptible individuals may contribute to, worsen, or even cause some conditions, including altered blood pressure, compromised immune status, headaches, cardiovascular problems, aberrant insulin metabolism, worsening of asthma, back pain, and arthritis, gastrointestinal problems, and mood and behavior changes. 1 Russell E. Koren G. Rieder M. et al. Hair cortisol as a biological marker of chronic stress: current status, future directions and unanswered questions. Psychoneuroendocrinology. 2012; 37: 589-601 Abstract Full Text Full Text PDF PubMed Scopus (595) Google Scholar A role for stress in cancer metastasis is proposed. 2 Moreno-Smith M. Lutgendorf S.K. Sood A.K. Impact of stress on cancer metastasis. Future Oncol. 2010; 6: 1863-1881 Crossref PubMed Scopus (269) Google Scholar In certain individuals, stress reduction appears to attenuate disease effects or decrease disease progression. 3 Schneider R.H. Grim C.E. Rainforth M.V. et al. Stress reduction in the secondary prevention of cardiovascular disease: randomized, controlled trial of transcendental meditation and health education in Blacks. Circ Cardiovasc Qual Outcomes. 2012; 5: 750-758 Crossref PubMed Scopus (133) Google Scholar , 4 Baker J. Costa D. Nygaard I. Mindfulness-based stress reduction for treatment of urinary urge incontinence: a pilot study. Female Pelvic Med Reconstr Surg. 2012; 18: 46-49 Crossref PubMed Scopus (18) Google Scholar But does this relationship extend to kidney stone formation or to unusually aggressive or more complex stone problems? Chronic Stress and Calcium Oxalate Stone Disease: Influence on Blood Cortisol and Urine CompositionUrologyVol. 82Issue 6PreviewTo evaluate the influence of chronic stress (CS) on urine composition of calcium oxalate (CaOx) stone patients and controls. Full-Text PDF ReplyUrologyVol. 82Issue 6PreviewThe Editorial Comment provides an excellent summary of our current knowledge of the relation between stress and disease. That some acute stress reactions are necessary to protect us in dangerous situations is well known. However, when this kind of reaction is maintained continuously over a long period, it can become a risk factor for a variety of chronic illnesses. The objective of our study was to examine a possible link between chronic stress, measured from a multidimensional point of view, with one specific chronic illness: calcium oxalate (CaOx) stone disease. Full-Text PDF

Sacral Neuromodulation in Patients with Idiopathic Overactive Bladder after Initial Botulinum Toxin Therapy

We evaluated whether patients with overactive bladder and incontinence who discontinued intravesical botulinum toxin therapy can be successfully treated with sacral neuromodulation. All patients who were referred to our center after discontinuation of botulinum toxin-A between 2005 and 2010 were included in this observational study. All patients underwent test stimulation with sacral neuromodulation and were evaluated with voiding diaries. Success was defined as more than 50% improvement in leakage episodes. Successful test stimulation was subsequently followed by a definitive implant. Patient satisfaction with sacral neuromodulation therapy was evaluated 1 year after the definitive implant. A total of 20 patients were included in the study. Of these patients 17(85%) had discontinued botulinum toxin-A because of lack of efficacy and 3had been treated successfully with botulinum toxin-A but requested a more permanent solution. The mean interval between the botulinum toxin-A and the sacral neuromodulation test stimulation was 23 months. In 14 patients (70%) thetest stimulation was successful and they received a definitive implant. Of the 14patients 5 even showed a decrease of greater than 90% in leakage episodes. One year after implantation 11 patients (79%) were satisfied with the sacral neuromodulation treatment. Despite the small sample size, this study indicates that patients who are dissatisfied with or in whom botulinum toxin-A treatment fails can respond successfully to sacral neuromodulation. The success rate of the test stimulation was comparable to that of patients who have never been treated with botulinum toxin-A. The 1-year satisfaction rate was comparable that of patients without a history of botulinum toxin-A treatment.

Long-term efficacy and safety of questionnaire-based initiation of urgency urinary incontinence treatment

The objective of the study was to determine the longer-term efficacy and safety of initiating treatment for urgency-predominant urinary incontinence (UUI) in women diagnosed using a simple questionnaire rather than an extensive evaluation. Women completing a 12 week randomized controlled trial of fesoterodine therapy for UUI diagnosed by questionnaire were invited to participate in a 9 month, open-label continuation study. UUI and voiding episodes were collected using voiding diaries. Participant satisfaction was measured by questionnaire. Safety was assessed by the measurement of postvoid residual volume and adverse event monitoring; if necessary, women underwent a specialist evaluation. The longitudinal changes in UUI and voiding episodes were evaluated using linear mixed models adjusting for baseline. Of the 567 women completing the randomized trial, 498 (87.8%) took at least 1 dose of medication during this open-label study. Compared with the baseline visit in the randomized trial, fesoterodine was associated with a reduction in total incontinence episodes per day and urgency incontinence episodes per day at the end of the open-label study (adjusted mean [SE], 4.6 [0.12] to 1.2 [0.13] and 3.9 [0.11] to 0.9 [0.11], respectively, P < .0001 for both). Most women were satisfied with treatment (89%, 92%, and 93% at 3, 6, and 9 months, respectively). Twenty-six women experienced 28 serious adverse events, 1 of which was considered possibly treatment related. Twenty-two women had a specialist evaluation: 5 women's incontinence was misclassified by the 3 Incontinence Questions; none experienced harm because of misclassification. Using a simple validated questionnaire to diagnose and initiate treatment for UUI in community-dwelling women is safe and effective, allowing timely treatment by primary care practitioners.

Transcutaneous Parasacral Electrical Neural Stimulation in Children with Primary Monosymptomatic Enuresis: A Prospective Randomized Clinical Trial

Parasacral transcutaneous electrical neural stimulation is widely used to treat hyperactive bladder in children and adults. Its use in nonmonosymptomatic enuresis has demonstrated improvement in number of dry nights. We assessed the effectiveness of parasacral transcutaneous electrical neural stimulation in the treatment of monosymptomatic primary enuresis. This prospective randomized clinical trial included 29 girls and 16 boys older than 6 years with primary monosymptomatic enuresis. Children were randomly divided into 2 groups consisting of controls, who were treated with behavioral therapy, and an experimental group, who were treated with behavioral therapy plus 10 sessions of parasacral transcutaneous electrical neural stimulation. Neural stimulation was performed with the electrodes placed in the sacral region (S2/S3). Sessions always followed the same pattern, with duration of 20 minutes, frequency of 10 Hz, a generated pulse of 700 μs and intensity determined by the sensitivity threshold of the child. Sessions were done 3 times weekly on alternate days. Patients in both groups were followed at 2-week intervals for the first month and then monthly for 6 consecutive months. Rate of wet nights was 77% in controls and 78.3% in the experimental group at onset of treatment (p = 0.82), and 49.5% and 31.2%, respectively, at the end of treatment (p = 0.02). Analyzing the average rate of improvement, there was a significantly greater increase in dry nights in the group undergoing neural stimulation (61.8%) compared to controls (37.3%, p = 0.0038). At the end of treatment percent improvement in children undergoing electrical stimulation had no relation to gender (p = 0.391) or age (p = 0.911). Treatment of primary monosymptomatic enuresis with 10 sessions of parasacral transcutaneous electrical neural stimulation plus behavioral therapy proved to be effective. However, no patient had complete resolution of symptoms.

Randomized trial of a comparison of rehabilitation or drug therapy for urgency urinary incontinence: 1-year follow-up

Our goal was to compare the long-term efficacy of bladder training (BT), pelvic floor muscle training (PFMT), combined pelvic floor rehabilitation (CPFR), and drug therapy (DT) in patients with urgency urinary incontinence (UUI). This multicenter single-blind randomized controlled trial compared the efficacy of BT, PFMT, DT, and CPFR at baseline and 3- and 12-month follow-ups. Outcome measures included number of voids/24 h, number of UUI episodes, Quality of Life related to UUI (QOL-rUI), urogynecologic visual analog scale, and self-reported function and disability. A significant improvement was found for all treatment groups at 3 and 12 months in urinary frequency, UUI episodes, QOL-rUI, and number of daily pads. Only CPFR showed a significant decrease of 4 voids/24 h and a significant increase in self-reported function. The study demonstrated long-term benefits of DT, BT, PFMT, and CPFR in the treatment of UUI with a slight advantage for CPFR.

What is the success of drug treatment in urge urinary incontinence? What should be measured?

The aim of this study is to evaluate the efficacy and the tolerability of three classic antimuscarinic drugs used in the treatment of over active bladder syndrome using clinical data and quality of life tests, and to evaluate the parameters affecting the success of these drugs. A total of 90 patients with urge urinary incontinence were randomly allocated into three groups either to receive tolterodine (group A), trospium chloride (group B) or oxybutynin (group C). Urogenital distress inventory short form (UDI-6) and Incontinence impact questionnaire short form (IIQ-7) of the Turkish Urogynecology and Pelvic Reconstructive Surgery Association were performed to each patient before and after treatment to evaluate the effectiveness and tolerability of the antimuscarinic drugs. Adverse events were also recorded during treatment. Improved urodynamic test values were recorded after 6 weeks of treatment in each group. Similarly, statistically significant differences were observed in UDI-6 and IIQ-7 test scores before and after treatment. Complete cure was achieved in 86 % of patients in group A; however, complete cure rates were 67 and 80 % in group B and C, respectively. Although, patients reported comparable tolerability against trospium chloride (77 %) and tolterodine (80 %), only 23 % of patients using oxybutynin considered the drug as tolerable. The most common side effect was dry mouth, followed by insomnia. Both dry mouth and insomnia was highest in group C (50 %). One patient (0.3 %) in group B and two patients (0.7 %) in group C reported that they did not want to continue to use the drug. Antimuscarinic medications are very successful in the treatment of urge urinary incontinence; however, the success of treatment is not only limited to clinical improvement. Patients do not regard a drug as successful unless it is tolerable, easy to adapt to the daily life and improve the quality of life even it has very successful clinical outcomes.

The Effect of Urodynamic Testing on Clinical Diagnosis, Treatment Plan and Outcomes in Women Undergoing Stress Urinary Incontinence Surgery

We evaluated the influence of preoperative urodynamic studies on diagnoses, global treatment plans and outcomes in women treated with surgery for uncomplicated stress predominant urinary incontinence. We performed a secondary analysis from a multicenter, randomized trial of the value of preoperative urodynamic studies. Physicians provided diagnoses before and after urodynamic studies and global treatment plans, defined as proceeding with surgery, surgery type, surgical modification and nonoperative therapy. Treatment plan changes and surgical outcomes between office evaluation and office evaluation plus urodynamic studies were compared by the McNemar test. Of 315 subjects randomized to urodynamic studies after office evaluation 294 had evaluable data. Urodynamic studies changed the office evaluation diagnoses in 167 women (56.8%), decreasing the diagnoses of overactive bladder-wet (41.6% to 25.2%, p <0.001), overactive bladder-dry (31.4% to 20.8%, p = 0.002) and intrinsic sphincter deficiency (19.4% to 12.6%, p = 0.003) but increasing the diagnosis of voiding dysfunction (2.2% to 11.9%, p <0.001). After urodynamic studies physicians canceled surgery in 4 of 294 women (1.4%), changed the incontinence procedure in 13 (4.4%) and planned to modify mid urethral sling tension (more or less obstructive) in 20 women (6.8%). Nonoperative treatment plans changed in 40 of 294 women (14%). Urodynamic study driven treatment plan changes were not associated with treatment success (OR 0.96, 95% CI 0.41, 2.25, p = 0.92) but they were associated with increased postoperative treatment for urge urinary incontinence (OR 3.23, 95% CI 1.46, 7.14, p = 0.004). Urodynamic studies significantly changed clinical diagnoses but infrequently changed the global treatment plan or influenced surgeon decision to cancel, change or modify surgical plans. Global treatment plan changes were associated with increased treatment for postoperative urgency urinary incontinence.

Success rates, quality of life, and feasibility of sacral nerve stimulation in elderly patients: 1-year follow-up

Urgency urinary incontinence (UUI) frequently occurs in elderly. International guidelines recommend pharmacological therapy as first-line treatment, but elderly do not respond in many cases. The purpose of this study was to report cure rates, quality of life, and feasibility of sacral neurostimulation (SNS) as an alternative option in the elderly. From October 2008 to April 2010, women >65 years with UUI who were refractory to pharmacological treatments were enrolled in this study and underwent SNS. At 12 months after surgery, patients were asked to compile a 3-day voiding diary and a urogynecologic standardized questionnaire: the Overactive Bladder Questionnaire (OAB-q). Eighteen patients met our inclusion criteria. Fifteen (83.3 %) underwent implantation of the neuromodulator. Twelve months after surgery, an overall success rate of 83.3 % was registered. A statistically significant difference (P<0.0001) between baseline and postsurgery OAB-q scores was recorded. SNS can be considered an alternative treatment for UUI in older women.

Evaluation of Stress Predominant Urinary Incontinence

Urodynamic studies (UDS) have been used to objectively characterize a patient’s complaint of urinary incontinence. Presumably, the clinician can utilize the UDS data to guide treatment options. It is even hoped that UDS can help predict which treatments should be utilized to produce the most effective outcomes. However, is this currently the case? The Urinary Incontinence Treatment Network (UITN) has completed four large randomized clinical trials related to treatments for urinary incontinence. Two trials compared outcomes of different surgeries for stress urinary incontinence (SUI) in which standardized UDS protocols were used. Secondary analyses of these UDS data showed that UDS were neither prognostic of treatment outcomes nor correlative with severity of UI symptoms, suggesting limited utility of UDS in the evaluation and management of the uncomplicated SUI patient. A third trial was designed to answer whether a basic office examination is not noninferior to UDS in affecting SUI surgical outcomes. The results of this study are currently in press. A fourth trial examined treatment of urgency urinary incontinence (UUI). Because UDS was not part of this trial, the utility of UDS in management and treatment of UUI could not be assessed. In summary, UDS will need to undergo further refinements to increase its clinical effectiveness in the area of urinary incontinence.

Patient Related Factors Associated with Long-Term Urinary Continence After Burch Colposuspension and Pubovaginal Fascial Sling Surgeries

We examined preoperative and postoperative patient related factors associated with continence status up to 7 years after surgery for stress urinary incontinence. Women randomized to Burch colposuspension or fascial sling surgery and assessed for the primary outcome of urinary continence 2 years after surgery were eligible to enroll in a prospective observational study. Survival analysis was used to investigate baseline and postoperative factors in the subsequent risk of stress urinary incontinence, defined as self-report of stress urinary incontinence symptoms, incontinence episodes on a 3-day diary or surgical re-treatment. Of the women who participated in the randomized trial 74% (482 of 655) were enrolled in the followup study. Urinary continence rates decreased during a period of 2 to 7 years postoperatively from 42% to 13% in the Burch group and from 52% to 27% in the sling group, respectively. Among the baseline factors included in the first multivariable model age (p = 0.03), prior stress urinary incontinence surgery (p = 0.02), menopausal status (0.005), urge index (0.006), assigned surgery (p = 0.01) and recruiting site (p = 0.02) were independently associated with increased risk of incontinence. In the final multivariable model including baseline and postoperative factors, Burch surgery (p = 0.01), baseline variables of prior urinary incontinence surgery (p = 0.04), menopausal status (p = 0.03) and postoperative urge index (p <0.001) were each significantly associated with a greater risk of recurrent urinary incontinence. Preoperative and postoperative urgency incontinence symptoms, Burch urethropexy, prior stress urinary incontinence surgery and menopausal status were negatively associated with long-term continence rates. More effective treatment of urgency urinary incontinence in patients who undergo stress urinary incontinence surgery may improve long-term overall continence status.

Pelvic floor muscle training for urgency urinary incontinence in women: a systematic review

The objective of this study is to evaluate the effectiveness of existing physiotherapy modalities for the treatment of urge urinary incontinence (UUI). A systematic review was performed for primary studies of physiotherapy techniques for UUI published in English between 1996 and August 2010 in major electronic databases. Only randomized clinical trials that reported outcomes separately for women with UUI were included. Outcomes assessed were reduction in UUI, urinary frequency, and nocturia. Data from 13 full-text trials including the modalities of pelvic floor muscles exercises with or without biofeedback, vaginal electrical stimulation, magnetic stimulation, and vaginal cones were analyzed. The methodologic quality of these trials was fair. Significant improvement in UUI was reported for all physiotherapy techniques except vaginal cone therapy. There are insufficient data to determine if pelvic physiotherapy improves urinary frequency or nocturia. Evidence suggests that physiotherapy techniques may be beneficial for the treatment of UUI.

Mindfulness-Based Stress Reduction for Treatment of Urinary Urge Incontinence

The objective of the study was to evaluate if a mindfulness-based stress reduction program is a viable treatment worthy of further evaluation for the treatment of urinary urge incontinence. This was a single-arm pilot study of 7 women who participated in an 8-week mindfulness-based stress reduction program to evaluate its effectiveness in reducing urinary leakage episodes. Improvement was measured by 3-day bladder diary, Overactive Bladder Symptom and Quality of Life-Short Form, Health-Related Quality of Life, and Patient Global Impression of Improvement. Outcome data were analyzed by means of paired t tests. Mean incontinence episodes per day decreased from 4.14 (SD, 1.96; range, 2.67-7.67) at baseline to 1.23 (SD, 0.93; range, 0.33-2.67) after treatment (P = 0.0005 for change). After treatment, 5 of 7 women were improved based on the Patient Global Impression of Improvement, and 2 were unchanged. Significant improvements on both Health-Related Quality of Life and Overactive Bladder Symptom and Quality of Life-Short Form were reported after treatment. Results were sustained at 1 year in 4 of 7 women. Two women sought treatment, and one was lost to follow-up at 12 months. Mindfulness-based stress reduction appears to be a treatment worthy of further study, as in the short term, it is as effective as historical studies of drug treatment and bladder training in reducing urge incontinence and incontinence-related quality of life.