Urge Urinary Incontinence In Women Research Articles

Associations Between Serum Estrogen Levels and Urinary Incontinence in Women: A Cross-sectional Analysis of NHANES 2013 to 2016

ObjectiveTo explore the relationship between serum estrogen levels and UI in a nationally representative female population. Materials and MethodsWe included women who had serum estradiol measurements and self-reported urinary incontinence problems in the 2013-2016 National Health and Nutrition Examination Survey cycles. A weighted multivariable logistic regression model was used to determine the association between urinary incontinence and serum estrogen levels after adjusting for age, race, Body Mass Index, diabetes, venipuncture, hypertension, poverty-to-income ratio, smoking, marital status, alcohol use, education and menopause. ResultA total of 4114 individuals were ultimately included in our study. Of these women 1200 (29.17%) complained of urge urinary incontinence (UUI), 1674 (40.69%) complained of stress urinary incontinence (SUI), 730 (17.74%) complained of mixed urinary incontinence (MUI). Women in the lowest quartile of serum estrogen were more likely to complain of UUI compared to those in the highest quartile (OR = 1.885; 95% CI = 1.042 - 3.412, p = 0.039). No association was noted between serum estrogen levels and SUI or MUI. ConclusionOur study shows a significant association between low serum estrogen level and the increased likelihood of UUI in women. Further research is required to validate our findings, elucidate the physiological mechanisms that underlie them, and assess potential therapeutic implications.

Non-Pharmacological Management of Urge Urinary Incontinence in Women between 40 and 65 Years Old: A Systematic Review.

Urinary incontinence (UI) has been identified as a World Health Organization health priority. In particular, urge UI (UUI) refers to urine leakage associated with a sudden and compelling desire to void urine. It affects quality of life more than other kinds of UI, but it is not always treated adequately. For these reasons, this study aimed to evaluate the effectiveness of conservative treatment practices to counteract UUI in women aged 40-65 years old. This systematic review was conducted following the Joanna Briggs Institute (JBI) methodology. According to the protocol registered in PROSPERO, a systematic search was carried out in the CINAHL, Embase, PubMed, PsycInfo, Scopus and Web of Science databases up to October 2022, to find primary studies meeting the inclusion criteria. Fourteen studies were included. The scientific literature reported different strategies dealing with the problem of UUI, some purely physical, others physical and psycho-educational and others exclusively psychological. Conservative treatments are useful to aid the reduction in UUI episodes in middle-aged women. However, none of them can be considered more effective than others due to the impossibility of conducting meta-analytical analyses. Further studies comparing the effectiveness of conservative treatments for UUI are needed.

U-shaped association between sleep duration and urgency urinary incontinence in women: a cross-sectional study.

To investigate the association between sleep duration and urgency urinary incontinence (UUI) among adult women. Cross-sectional data were retrieved from the 2005-2014 National Health and Nutrition Examination Survey. To explore the association between sleep duration and urgency urinary incontinence, multivariable logistic regression and restricted cubic spline (RCS) regression analysis was carried out. Among 9204 adult women, the weighted urinary incontinence prevalence was 31% for urgency urinary incontinence (UUI). The fully adjusted multivariable model revealed that participants with short (< 7h) or long (> 9h) sleep duration were more likely to report UUI compared to participants with normal (7-9h) sleep duration (OR 1.20, 95% CI 1.03-1.40, p = 0.02, OR 1.40, 95% CI 1.11-1.76, p = 0.005, respectively). Subgroup analysis showed no significant interaction. Furthermore, additional analysis demonstrated a U-shaped correlation between sleep duration and incident UUI. The non-linear association exists between sleep duration and urgency urinary incontinence. Compared with insufficient or excessive sleep, normal sleep duration is related to lower prevalence of urgency urinary incontinence. Future prospective longitudinal studies should be conducted to further investigate and determine the degree of the association between sleep time and urgent urinary incontinence.

Associations Between Bacterial Vaginosis and Urgency Urinary Incontinence in Women: An Analysis of Nhanes 2001 to 2004

ObjectiveTo investigate the relationship between bacterial vaginosis (BV) and urinary incontinence (UI) in American women. Materials and methodsData from the National Health and Nutrition Examination Survey (NHANES) from 2001 to 2004 were merged. Self-collected vaginal swabs were used to assess BV. Urinary incontinence was determined by self-report. Multivariable logistic regression models were used to assess the association between BV and UI in American women, controlling for potential confounders. ResultsOverall, 31.3% of female respondents tested positive for bacterial vaginosis. Women with bacterial vaginosis were more likely to report stress urinary incontinence (SUI) (22.78% vs 17.79%), urgency urinary incontinence (UUI) (12.86% vs 7.26%) and mixed urinary incontinence (MUI) (7.35% vs 4.42%) than women without bacterial vaginosis. In the adjusted analysis, women with bacterial vaginosis had 1.47 times greater odds of urgency urinary incontinence (OR 1.47, 95% CI 1.07-2.17, P = .0160), and bacterial vaginosis did not increase the odds of stress urinary incontinence and mixed urinary incontinence in women. ConclusionAfter controlling for known risk factors, bacterial vaginosis seems to be significantly related to female urgency urinary incontinence. However, the cross-sectional nature of this study does not allow the conclusion of causality. Further basic and cohort studies are needed to examine the association of BV with UUI.

Predicting outcomes after intradetrusor onabotulinumtoxina for non-neurogenic urgency incontinence in women.

Develop models to predict outcomes after intradetrusor injection of 100 or 200 units of onabotulinumtoxinA in women with non-neurogenic urgency urinary incontinence (UUI). Models were developed using 307 women from two randomized trials assessing efficacy of onabotulinumtoxinA for non-neurogenic UUI. Cox, linear and logistic regression models were fit using: (1) time to recurrence over 12 months, (2) change from baseline daily UUI episodes (UUIE) at 6 months, and (3) need for self-catheterization over 6 months. Model discrimination of Cox and logistic regression models was calculated using c-index. Mean absolute error determined accuracy of the linear model. Calibration was demonstrated using calibration curves. All models were internally validated using bootstrapping. Median time to recurrence was 6 (interquartile range [IQR]: 2-12) months. Increasing age, 200 units of onabotulinumtoxinA, higher body mass index (BMI) and baseline UUIE were associated with decreased time to recurrence. The c-index was 0.63 (95% confidence interval [CI]: 0.59, 0.67). Median change in daily UUIE from baseline at 6 months was -3.5 (IQR: -5.0, -2.3). Increasing age, lower baseline UUIE, 200 units of onabotulinumtoxinA, higher BMI and IIQ-SF were associated with less improvement in UUIE. The mean absolute error predicting change in UUIE was accurate to 1.6 (95% CI: 1.5, 1.7) UUI episodes. The overall rate of self-catheterization was 17.6% (95% CI: 13.6%-22.4%). Lower BMI, 200 units of onabotulinumtoxinA, increased baseline postvoid residual and maximum capacity were associated with higher risk of self-catheterization. The c-index was 0.66 (95% CI: 0.61, 0.76). The three calculators are available at http://riskcalc.duke.edu. After external validation, these models will assist clinicians in providing more accurate estimates of expected treatment outcomes after onabotulinumtoxinA for non-neurogenic UUI in women.

Cognitive-behavioral therapy and urge urinary incontinence in women. A systematic review.

UUI co-exists with numerous health conditions, having a substantial negative impact on health-related quality of life and mental health. Cognitive-behavioral therapy (CBT) could help patients manage these problems by changing the way they think and behave. We carried out a systematic review of the literature assessing the modalities and effects of CBT as a stand-alone strategy, without adding PFMT, on symptoms and clinical signs, in women with UUI. Our secondary objective was to report modalities and effects of CBT on health-related quality of life, psychological symptoms and patient-reported satisfaction. The PRISMA methodology was used to carry out this systematic review. A literature search was conducted in PubMed, PEDro, Web of Science and Cochrane Library databases from inception to December 2020. The PICO approach was used to determine the eligibility criteria. Twelve papers were included in the present review which showed beneficial effects on both symptom severity (p < 0.05) and more subjective areas such as quality of life, psychological symptoms or patient satisfaction level (p < 0.05), respectively). However, results on the effectiveness of CBT on clinical signs remains conflicting. Based on the available literature, this review suggested a high level of evidence for the effectiveness of CBT on symptom severity and a moderate level of evidence for the effectiveness of CBT on quality of life, psychological symptoms and patient satisfaction. However, we highlighted no evidence for the effects of CBT on clinical signs.

Vitamin D intake and the 10-year risk of urgency urinary incontinence in women

Evidence indicates that higher serum 25-hydroxy vitamin D levels may be associated with decreased prevalence of urgency urinary incontinence (UI), but the impact of vitamin D consumption on development of urgency and mixed UI is unclear. The objective was to assess whether greater vitamin D intake was associated with decreased risk of incident urgency and mixed UI over 10 years using 2 large prospective cohorts of middle-aged and older women. We analyzed 38,101 women from the Nurses’ Health Study I (NHS I) and 35,190 women from NHS II who were free of UI at baseline. We followed incident UI, defined as new UI occurring at least monthly, separately by subtype (urgency, mixed, stress UI), from 2002-2012. We categorized vitamin D intake from supplements and diet. We estimated relative risk for developing UI according to vitamin D intake using Cox-proportional hazard models with adjustment for covariates. Median vitamin D intake was 580IU in the older women in NHS I (age range 56–71 at baseline) and 487IU in middle-aged women in NHS II (age range 40–57). Among women taking ≥1000IU of vitamin D, median intake in the older women was 1252IU and 1202IU in the middle-aged women. Among the older women, we found no relation of vitamin D intake to risk of developing UI, across all UI subtypes. In multivariable-adjusted analysis for middle-aged women, the relative risk of developing mixed UI among women taking >1000IU was 0.79 (0.63, 0.99) and for urgency UI was 0.88 (0.71, 1.07), versus <200IU. Risks of developing stress UI were not related to vitamin D intake categories. Overall, we did not find a relationship between vitamin D intake and UI incidence in middle-aged and older women; however, the reported intake was moderate.

Evidence of Common Pathophysiology Between Stress and Urgency Urinary Incontinence in Women.

Urinary incontinence in women is commonly categorized as stress urinary incontinence (SUI) and urgency urinary incontinence (UUI). SUI occurs due to an increased intra-abdominal pressure caused by an unstable anatomical outlet of the bladder and can be successfully treated surgically. UUI, a combination of a symptom (urgency to void) and urinary incontinence, is considered to be caused by a neurological dysfunction of the bladder. Current treatment options can reduce the feeling of urgency, but effects on restoration of continence are less impressive. However, surgery for pelvic organ prolapse reduction leads to cure UUI, indicating a critical role of pelvic anatomy in the etiology of UUI. We hypothesized that incontinence in patients with UUI is caused by an anatomical instability at the bladder outlet leading to incontinence even under minor physical stress exerted on the bladder base. Patients with UUI symptoms were asked to specify exactly when (in which body position) they involuntary lose urine after the feeling of urgency to void. In total, 569 patients were evaluated between 2012 and 2020. Overall, 96% of the patients lost urine when they got up from a sitting position on their way to the toilet. Of the total study patients 3% lost urine already in the sitting position when they felt the urgency to void. The current treatment options for UUI are based on the hypothesis that UUI is a neurological disorder. This study demonstrated that urinary incontinence in patients with UUI is dependent on an intact anatomical stability of the urethro-vesical junction under pressure. Therefore, treatment modalities should focus on the anatomical repair or support in that area.

The Correlation between Overactive Bladder Symptoms and Urodynamic Findings in Men and Women

Abstract Background: Overactive Bladder (OAB) is defined by the International Continence Society (ICS) as urgency, with or without urge incontinence (UUI), usually with frequency and nocturia, if there is no proven infection or other etiology. Aim of Study: To evaluate the correlation between over-active bladder symptoms (OAB) and urodynamic Detrusor Overactivity (DO) in non neurogenic bladder in both genders. Patients and Methods: We reviewed the records of 202 patients who attended Al-Zahra'a Univesity Hospital between October 2013 and October 2018 with overactive bladder symptoms urgency, with or without urge urinary incontinence usually with frequency and nocturia, with presence or absence of DO in two groups. All patients were subjected to: Full history taking, voiding diary, clinical examination, laboratory investigations, radiological investigations, urodynamic studies (UDS) and cystoscopic biopsies for histopathological exam-ination. Also we evaluate OAB symptoms, urodynamic pa-rameters with histopathological findings. All patients under-went uroflowmetry: The maximum flow rate, average flow rate and voided volume were recorded. Post Voiding Residual urine (PVR) volume was recorded. Cystometry: The intravesi-cal, intra-abdominal, detrusor pressure, first desire to void, strong desire to void, Maximum Cystometric Capacity (MCC), total volume infused, bladder compliance and detrusor over-activity were evaluated. Cystoscopy and random bladder biopsies from all patients and stained with Hematoxylin and Eosin for histopathological examination of smooth muscle, the urothelium, lamina propria, and adventitia. We used another special stain Massons trichrome to visualize collagen and degenerative changes of smooth muscle bundles. Results: Detrusor overactivity DO was diagnosed in (63.36%) 128 OAB patients after urodynamic studies. Of men 42.9% and 36.1% of women with urgency had DO (OAB dry) while 57.1 % of male 63.9% of female patients with urgency and Urge Urinary Incontinence (UUI) were (OAB wet) had DO. Of women 23.8% with no DO were also OAB wet having urodynamic Stress Urinary Incontinence (SUI). Combination of symptoms was more precise in predicting DO in OAB patients. Patchy areas of myohypertrophic and degenerative histological pattern were observed more in group I in both male and female patients. Conclusions: We concluded that there was better correla-tion between OAB symptoms and the urodynamic diagnosis of DO in women than in men, wet OAB more in women than in men in the same group I. Urgency, frequency and UUI in men, nocturia and UUI in women were significantly increased in predicting DO. Combination of objective parameters from the bladder diary, filling cystometry and histopathological findings have a better correlation with the occurrence of DO.

Proximal location of explanted midurethral slings is associated with urinary storage symptoms.

To examine the location of midurethral slings (MUS) at the time of excision to determine associations between presenting symptoms and sling location at explant. We performed an IRB approved, retrospective review of MUS explants between January 2011 and March 2016. Symptoms and physical examination findings were compared between women with slings explanted from the mid-urethra (MU) and women with slings explanted from the proximal urethra/bladder neck (PU/BN). We included 95 consecutive women who underwent MUS explant in the analysis. Presenting symptoms included pain in 69 women (72.6%), urinary urgency in 66 (66.5%), voiding dysfunction in 55 (57.9%), urge urinary incontinence (UUI) in 41 (43.2%), stress urinary incontinence in 34 (35.8%), and recurrent urinary tract infections in 22 (23.2%). At sling explant, 2 (2.1%) slings were found at the distal urethra, 33 (34.7%) at the MU and 60 (63.2%) at the PU/BN. Women with slings explanted from the PU/BN were more likely to present with urgency (78.3% vs54.5%; P = 0.017) and UUI (53.3% vs27.3%; P = 0.015) and less likely to present with pain on examination (48.3% vs75.8%; P = 0.01). The majority of MUS requiring explant in this cohort were found at the PU/BN. The most common presenting symptom before MUS explant was pain, followed by urgency and voiding dysfunction. PU/BN location of MUS is likely a factor in the development of urgency and UUI in women who ultimately undergo explant.

PD03-11 EXPANDED QUANTITATIVE CULTURE (EQC) DETECTS UNIQUE LIVE BACTERIA FROM KIDNEY STONES

You have accessJournal of UrologyStone Disease: Basic Research & Pathophysiology I1 Apr 2018PD03-11 EXPANDED QUANTITATIVE CULTURE (EQC) DETECTS UNIQUE LIVE BACTERIA FROM KIDNEY STONES Petar Bajic, Michelle Van Kuiken, Bethany Burge, Alan Wolfe, Andrew Schwaderer, Bodo Knudsen, Larissa Bresler, Ahmer Farooq, Thomas Turk, and Kristin Baldea Petar BajicPetar Bajic More articles by this author , Michelle Van KuikenMichelle Van Kuiken More articles by this author , Bethany BurgeBethany Burge More articles by this author , Alan WolfeAlan Wolfe More articles by this author , Andrew SchwadererAndrew Schwaderer More articles by this author , Bodo KnudsenBodo Knudsen More articles by this author , Larissa BreslerLarissa Bresler More articles by this author , Ahmer FarooqAhmer Farooq More articles by this author , Thomas TurkThomas Turk More articles by this author , and Kristin BaldeaKristin Baldea More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.277AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES While struvite stones are associated with colonization by urease-producing bacteria, the relationship between bacteria and stones remains otherwise poorly defined. Standard stone culture (SSC) identifies bacteria in 15-70% of stones, with E. coli and urease-producers predominating. SSC protocols are not conducive to growth by slow-growing, fastidious or anaerobic bacteria which comprise the vast majority of the urinary tract microbiota. Using EQC, we characterize the stone microbiome, specifically as it relates to stone composition. METHODS Stones were extracted from 70 patients; 22 undergoing percutaneous nephrolithotomy (PCNL) and 48 undergoing ureteroscopy (URS). All had pre-operative urinalysis or standard urine culture negative for infection. All patients received perioperative antibiotics. A portion of stone was sent for EQC and the remainder was sent for chemical analysis. Our EQC protocol utilizes 10-20x more specimen than SSC and a standardized homogenization technique. Colonies grown were identified using mass spectrometry. Relative abundance of bacterial species was compared to stone composition. RESULTS We identified growth from 22/70 (31.4%) stones with 90.9% of those being non-struvite. Growth was noted in 2/5 (40%) struvite, 7/18 (38.9%) calcium phosphate, 12/44 (27.3%) calcium oxalate and 1/6 (16.7%) uric acid dominated stones. The most common genera isolated were Staphylococcus (33.3%), Lactobacillus (16.7%) and Candida (13.3%). Lactobacillus, while not commonly associated with stones, was identified in 1 male and 4 female patients. Other unique species isolated include Aerococcus urinae and Streptococcus anginosus. CONCLUSIONS EQC detects diverse live bacteria from struvite and non-struvite stones following PCNL and URS, even following administration of perioperative antibiotics. Multiple traditionally non-uropathogenic bacteria were isolated, including Lactobacillus gasseri, Aerococcus urinae and Streptococcus anginosus. These three organisms have been associated with urge urinary incontinence in women in prior studies. While the clinical significance of these bacteria in stones remains unknown, further characterization of the stone microbiome may elucidate a pathophysiological relationship between bacteria and nephrolithiasis. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e75-e76 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Petar Bajic More articles by this author Michelle Van Kuiken More articles by this author Bethany Burge More articles by this author Alan Wolfe More articles by this author Andrew Schwaderer More articles by this author Bodo Knudsen More articles by this author Larissa Bresler More articles by this author Ahmer Farooq More articles by this author Thomas Turk More articles by this author Kristin Baldea More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Third-line treatment options for refractory urgency urinary incontinence in women—a commentary to ROSETTA trial

According to the American Urological Association (AUA) and Society of Urodynamics and Female Urology (SUFU) guidelines third-line treatment options for refractory overactive bladder (OAB) include: intradetrusor onabotulinumtoxinA injections (100 units, Botox, Allergan) or sacral neuromodulation (SNS), or peripheral tibial nerve stimulation (PTNS). Intravesical onabotulinumtoxinA injections are ranked as standard treatment (evidence strength: grade B), which is equally to the strongest statement. AUA/SUFU guidelines rank SNS and PTNS as recommended option (evidence strength: grade C). Patients qualified for intravesical onabotulinumtoxinA injections should be warned about the potential risk of urine retention and must be willing to perform clean intermittent self-catheterization (CISC). Sacral neuromodulation may be offered to selected patients, who are willing to undergo two-step surgical procedure (1). SNS is also benefit for patients with idiopathic urinary retention and with urgency symptoms. However, there is still a lack of evidence, which third-line treatment option is superior in patients with refractory overactive bladder (OAB). Interestingly, in the recent study published by Hashim et al . (2) 34% patients with refractory OAB were willing to try sacral neuromodulation and only 9% of patients preferred intravesical Botox injections as a third-line treatment option. On the other hand it is much easier for physicians to inject the detrusor with onabotulinumtoxinA than implant the neurostimulator (the learning curve for Botox is very short and interestingly enough treatment effectiveness does not depend on the experience of performing physician). We should also remember about the cost of procedures. In many countries there is still no health reimbursement either for onabotulinumtoxinA nor SNS.

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 ...

Intermittent sacral neuromodulation for idiopathic urgency urinary incontinence in women.

SNM has been proven to be effective in the treatment of refractory UUI. Total costs and patient burden due to regular battery changes may prevent broad implementation of this treatment. The aim was to achieve a minimal improvement of 50% in incontinence episodes compared to pre-SNM by using iSNM. This prospective cohort study was performed in women with UUI receiving treatment with SNM for a minimum of 6 months. The neurostimulator was programmed to 8 hr "on" and 16 hr "off" per day for 12 weeks. Prior to iSNM, data were collected during no SNM and cSNM. Bladder diaries and various patient reported outcome measures were collected at predetermined time points: 1-5 weeks, and 8, 12, and 16 weeks. Nonparametric tests were used for the statistical analysis. Of the 19 patients 63% showed an improvement of >50% of incontinence episodes during iSNM compared to pre-SNM. Bladder diary parameters showed a difference between pre-SNM and iSNM median (P-value); incontinence episodes/24 hr, 4.1-1.0 (P = 0.04), incontinence severity, 2.0-1.0 (P = 0.001), voiding episodes/24 hr, 13.0-8.0 (P = 0.001), and voided volume, 149-219 ml (P = 0.04). The UDI-6, 50.0-27.8 (P = 0.03), and the IIQ-7 scores, 50.0-9.5 (P = 0.04) also showed a significant improvement. No difference was demonstrated between iSNM and cSNM. Compared to pre-SNM parameters, iSNM shows an improvement in both objective and subjective outcomes. Specifically no difference was found between iSNM and cSNM, indicating that iSNM could be a feasible and cost-effective alternative. Neurourol. Urodynam. 36:385-389, 2017. © 2015 Wiley Periodicals, Inc.

Genetic Contributions to Urgency Urinary Incontinence in Women

We identify genetic variants associated with urgency urinary incontinence in postmenopausal women. A 2-stage genome-wide association analysis was conducted to identify variants associated with urgency urinary incontinence. The WHI GARNET substudy with 4,894 genotyped post-reproductive white women was randomly split into independent discovery and replication cohorts. Genome-wide imputation was performed using IMPUTE2 with the 1000 Genomes ALL Phase I integrated variant set as a reference. Controls reported no urgency urinary incontinence at enrollment or followup. Cases reported monthly or greater urgency urinary incontinence and leaked sufficiently to wet/soak underpants/clothes. Logistic regression models were used to predict urgency urinary incontinence case vs control status based on genotype, assuming additive inheritance. Age, obesity, diabetes and depression were included in the models as covariates. Following quality control, 975,508 single nucleotide polymorphisms in 2,241 cases (discovery 1,102; replication 1,133) and 776 controls (discovery 405, replication 371) remained. Genotype imputation resulted in 9,077,347 single nucleotide polymorphisms and insertions/deletions with minor allele frequency greater than 0.01 available for analysis. Meta-analysis of the discovery and replication samples identified 6 loci on chromosomes 5, 10, 11, 12 and 18 associated with urgency urinary incontinence at p <10(-6). Of the loci 3 were within genes, the zinc finger protein 521 (ZFP521) gene on chromosome 18q11, the ADAMTS16 gene on chromosome 5p15 and the CIT gene on chromosome 12q24. The other 3 loci were intergenic. Although environmental factors also likely contribute, this first exploratory genome-wide association study for urgency urinary incontinence suggests that genetic variants in the ZFP521, CIT and ADAMTS16 genes might account for some of the observed heritability of the condition.

Vaginal estrogen use in postmenopausal women with pelvic floor disorders: systematic review and practice guidelines.

Risk of pelvic floor disorders increases after menopause and may be linked to estrogen deficiency. We aimed to systematically and critically assess the literature on vaginal estrogen in the management of pelvic floor disorders in postmenopausal women and provide evidence-based clinical practice guidelines. MEDLINE and Cochrane databases were searched from inception to July 2014 for randomized controlled trials of commercially available vaginal estrogen products compared with placebo, no treatment, or any medication for overactive bladder or urinary incontinence. We double-screened 1,805 abstracts and identified 12 eligible papers. Studies were extracted for participant information, intervention, comparator, efficacy outcomes, and adverse events, and they were individually and collectively assessed for methodological quality and strength of evidence. Evidence was generally of poor to moderate quality. Vaginal estrogen application before pelvic organ prolapse surgery improved the vaginal maturation index and increased vaginal epithelial thickness. Postoperative vaginal estrogen use after a midurethral sling resulted in decreased urinary frequency and urgency. Vaginal estrogen and immediate-release oxybutynin were similar in improvement of urinary urgency, frequency, and urgency urinary incontinence in women with overactive bladder, but oxybutynin had higher rates of side effects and discontinuation. Conversely, the addition of vaginal estrogen to immediate or extended-release tolterodine did not improve urinary symptoms more than tolterodine alone. One study reported an improvement in stress urinary incontinence with use of vaginal estrogen. Vaginal estrogen application may play a useful role as an adjunct in the management of common pelvic floor disorders in postmenopausal women.

Efficacy of various modes of therapy of the urge urinary incontinence in women

Efficacy of various modes of therapy of the urge urinary incontinence in women

Risk Factors for Urgency Incontinence in Women Undergoing Stress Urinary Incontinence Surgery

Objective. To determine baseline variables associated with urgency urinary incontinence (UUI) in women presenting for stress urinary incontinence (SUI) surgery. Methods. Baseline data from two randomized trials enrolling 1,252 women were analyzed: SISTEr (fascial sling versus Burch colposuspension) and TOMUS (retropubic versus transobturator midurethral sling). Demographic data, POP-Q measures, and validated measures of symptom severity and quality of life were collected. Charlson Comorbidity Index (CCI) and Patient Health Questionnaire-9 were measured in TOMUS. Multivariate models were constructed with UUI and symptom severity as outcomes. Results. Over two-thirds of subjects reported bothersome UUI at baseline. TOMUS patients with more comorbidities had higher UDI irritative scores (CCI score 0 = 39.4, CCI score 1 = 42.1, and CCI score 2+ = 51.0, P = 0.0003), and higher depression scores were associated with more severe UUI. Smoking, parity, prior incontinence surgery/treatment, prolapse stage, and incontinence episode frequency were not independently associated with UUI. Conclusions. There were no modifiable risk factors identified for patient-reported UUI in women presenting for SUI surgery. However, the direct relationships between comorbidity level, depression, and worsening of UUI/urgency symptoms may represent targets for preoperative intervention. Further research is necessary to elucidate the pathophysiologic mechanisms that explain the associations between these medical conditions and bladder function.

Re: Pessary Care: Follow up and Management of Complications

No AccessJournal of UrologyAdult Urology1 Apr 2013Re: Vaginal Support Pessaries: Indications for Use and Fitting Strategiesis companion ofRe: Persistence of Urgency and Urge Urinary Incontinence in Women with Mixed Urinary Symptoms After Midurethral Slings: A Multivariate AnalysisRe: Pessary Care: Follow up and Management of Complications Alan J. WeinM.D., Ph.D. (hon.) Alan J. WeinAlan J. Wein More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.12.068AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Re: Vaginal Support Pessaries: Indications for Use and Fitting Strategies." The Journal of Urology, 189(4), p. 1444 © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsRelated articlesJournal of Urology3 Jan 2013Re: Persistence of Urgency and Urge Urinary Incontinence in Women with Mixed Urinary Symptoms After Midurethral Slings: A Multivariate AnalysisJournal of Urology12 Dec 2018Re: Pessary Care: Follow up and Management of Complications Volume 189Issue 4April 2013Page: 1444 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alan J. Wein More articles by this author Expand All Advertisement PDF downloadLoading ...

Re: Persistence of Urgency and Urge Urinary Incontinence in Women with Mixed Urinary Symptoms After Midurethral Slings: A Multivariate Analysis

No AccessJournal of UrologyAdult Urology1 Apr 2013Re: Factors Associated with Urge Urinary Incontinence After Surgery for Stress Urinary Incontinence Alan J. WeinM.D., Ph.D. (hon.) Alan J. WeinAlan J. Wein More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.12.076AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Re: Factors Associated with Urge Urinary Incontinence After Surgery for Stress Urinary Incontinence." The Journal of Urology, 189(4), pp. 1446–1447 © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4April 2013Page: 1446-1447 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alan J. Wein More articles by this author Expand All Advertisement Loading ...