Urge Urinary Incontinence Research Articles

Application of Information-Motivation-Behavioural Skills Model on Older Women with Urge Urinary Incontinence: A Retrospective Study.

Urge urinary incontinence (UUI) commonly occurs in elderly female patients. The application research of the Information-Motivation-Behavioural Skills (IMB) model has been applied in various therapeutic contexts, but research on its application in UUI management is limited. Elderly female patients diagnosed with UUI were selected as the research subjects, and they were divided into two groups. All patients were given pelvic floor muscle training. The control group received routine health education management, whereas the observation group received health education management on the basis of the IMB model in addition to routine education. Before and after treatment, the severity of urinary incontinence was evaluated using a 1 h urine pad test. The anxiety and depression statuses were evaluated using Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS). Incontinence Quality-of-Life (I-QOL) was used to evaluate the quality of life of patients. After treatment, the leakage volume, SAS and SDS scores of both groups significantly decreased (p < 0.001), with the observation group having significantly lower leakage volume, SAS, and SDS scores than the control group (p < 0.001). The I-QOL scores of both groups increased (p < 0.001), and the observation group had significantly higher scores than the control group (p < 0.001). Health education interventions based on the IMB model can improve urinary leakage in elderly women with UUI, improve their negative emotions and enable them to have an enhanced quality of life.

The effect of pregnancy pilates-assisted childbirth preparation training on urinary incontinence and birth outcomes: a randomized-controlled study

PurposeTo examine the effect of pregnancy pilates-assisted birth preparation training on urinary incontinence (UI) including stress urinary incontinence (SUI) and urge urinary incontinence (UUI) during pregnancy, and the postpartum period and birth outcomes.MethodIn this single-center, single-blind, randomized, controlled study, 126 participants who have 28–30 weeks of gestation and nulliparous were randomly assigned to receive either the (n = 63) or control group (n = 63). The study was carried out between March and August 2022. Pregnancy pilates intervention was applied twice in a week, a total of 8 weeks to pilates group. The control group was given routine obstetric and pregnancy care. A personal data form and the Michigan Incontinence Severity Index Form (M-ISI) were used as data collection tools.ResultsThe mean weight gains of the experimental group during pregnancy were significantly lower than the control group. The experimental group had almost twice the rate of vaginal birth than those of the control group. The duration of labor mean score of experimental group was 5 h and 43 min less than the duration of labor of the control group (p < 0.001). After intervention, and postpartum period, the SUI and UUI severity of the experimental group was significantly lower than those of the control group (p < 0.001).ConclusionPilates-assisted childbirth preparation training reduced the severity of UI including SUI and UUI symptoms during pregnancy and the early postpartum. In addition, pilates-assisted childbirth preparation training contributes to decrease in weight gain during pregnancy, the increase in the vaginal birth rate, and the shortening of the duration of labor.Trial registrationNCT06185439

Symptoms of Lower Urinary Tract Dysfunction Research Network (LURN): An introduction to the Urinary Urgency Phenotyping Protocol LURN II.

The Symptoms of Lower Urinary Tract Dysfunction Research Network (LURN) is undertaking a new cohort study in LURN II including cases and controls. This new cohort was enrolled to specifically study urinary urgency and urgency urinary incontinence, lower urinary tract symptoms (LUTSs) that are often difficult to treat due to a lack of understanding of their phenotypes and pathophysiologies. This paper will focus on the motivation for the second iteration of LURN and highlight the new research techniques and plans for more thorough phenotyping of this population. This paper will outline the gaps in understanding in treating LUTSs, specifically urinary urgency.

Prevalence of urinary incontinence in nulliparous Indian sportswomen.

A common gynaecological problem among women that leads to a negative impact on quality of life and causes distress is the involuntary loss of urine which is addressed as urinary incontinence (UI). Females involved in playing various types of sports perform high-intensity activities which can serve as risk factors for UI and pelvic organ prolapse. According to the available literature, there is a scarcity of information regarding data on the prevalence of UI in Indian female athletes. Therefore, the purpose of the present study was to evaluate the prevalence of UI in nulliparous Indian sportswomen. For a duration of 6 months, a cross-sectional study was carried out in various sports centres across the states of Telangana, Maharashtra, Gujarat, and Delhi. A total of 560 nulliparous Indian female sportswomen were involved based on the selection criteria. The various sports involved were malkhamb, kabaddi, kushti, weightlifting, gymnastics, basketball, badminton, and athletics. All the participants were provided with a questionnaire for female UI diagnosis (QUID), which was the primary outcome measure. Out of 560 women enrolled in the study, the highest prevalence was found for stress urinary incontinence (SUI), consisting of 126 (22.5%) women, followed by mixed urinary incontinence (MUI), involving 49 (8.8%) women, and urge urinary incontinence (UUI), including 47 (8.4%) women. Additionally, the prevalence of UI was highest in obese and overweight Indian sportswomen. Moreover, the highest prevalence of SUI among women was for weightlifting, whereas for UUI and MUI, malkhamb and kushti sports were the most prevalent, respectively. The present study concluded that the highest prevalence among nulliparous Indian sportswomen was for SUI, followed by MUI and UUI. Additionally, weightlifting sport showed the highest prevalence for SUI, followed by malkhamb for UUI and kushti for MUI. The prevalence of UI in Indian sportswomen is important as it imparts knowledge and awareness among women and benefits professionals in designing appropriate preventive and rehabilitative protocols for curtailing such problems in the near future.

Long term safety, continuation rates and subjective and objective success of Posterior Tibial Nerve Stimulation for Overactive Bladder

Introduction:Posterior tibial nerve stimulation (PTNS) is currently offered to patients with refractory overactive bladder (OAB). We aim to evaluate the efficacy, safety and long-term continuation of PTNS over 11 years. Methods:We conducted a retrospective cohort study on all patients who underwent PTNS from 2012 to 2023. The primary outcomes were change in urinary frequency over 24 hours, maximum voided volume (MVV), number of episodes of urgency urinary incontinence (UUI) and patient perception of intensity of urgency scale (PPIUS). Results:We identified 81 patients. 83% of patients completed 12 treatments of PTNS, and 54% of those that did not complete their full course of treatment stated that this was due to inefficacy. 33% of patients underwent PTNS ‘top ups’ as needed. Only 1 patient reported an adverse effect of musculoskeletal leg pain.28% of patients reported a subjective improvement of their symptoms by 50% or more. There was an average reduction in daytime frequency by 0.6 episodes (p = 0.033), an increase in MVV by 13mls (p = 0.927), a reduction in UUI episodes each day by 0.7 (p = 0.008) and a reduction in average PPIUS by 0.4 (p = 0.024). Conclusion:PTNS remains a safe treatment option for patients with refractory OAB with evidence of both subjective and objective improvement to most symptoms. The majority of our patients completed a 12-week cycle but only 1 in 3 chose to have further PTNS ‘top ups’ and only 1 in 5 are continuing with PTNS for long term management of their OAB.

The Interaction Effect of Obesity with Sleep Duration on Urinary Incontinence in Adult Females: A Cross-Sectional Study of the NHANES Database.

This study aimed to explore the interaction between obesity and sleep duration on urinary incontinence (UI) in adult women. Data of adult females were extracted from the National Health and Nutrition Examination Surveys (NHANES) database in 2005-2018 in this cross-sectional study. Weighted univariate and multivariate logistic regression analyses were utilized to screen covariates and investigate the associations of obesity and sleep duration with 3 types of UI, including stress urinary incontinence (SUI), urgency urinary incontinence (UUI), and mixed urinary incontinence (MUI). In addition, the interaction effect between obesity and sleep duration on UI was assessed. The evaluation indexes were odd ratios (ORs) and 95% confidence intervals (CIs), relative excess risk due to interaction (RERI), attributable proportion of interaction (AP), and synergy index (S). Among 13,692 eligible women, 6,063 had SUI, 4,370 had UUI, and 2,621 had MUI. After adjusting for the covariates, women with obesity had higher odds of SUI (OR = 1.78, 95% CI: 1.59-2.00), UUI (OR = 1.84, 95% CI: 1.63-2.06), and MUI (OR = 1.67, 95% CI: 1.48-1.88), compared with those who without obesity. Similarly, comparing to adequate sleep, sleep deprivation and hypersomnia were both significantly linked to higher odds of all types of UI (all p &lt; 0.05). The restricted cubic spline (RCS) curves showed that there is a U-shaped association of sleep duration with UUI and MUI, respectively (all non-line p &lt; 0.05). In addition, there was a potential synergistic effect between obesity and hypersomnia on UUI (RERI = 0.576, AP = 0.243, and S = 1.729) and that on MUI (RERI = 0.821, AP = 0.339, and S = 2.373). Obesity and hypersomnia had a potential synergistic effect on UI, especially UUI and MUI. Adult women should adopt measures to keep BMI within normal range, and timely intervene hypersomnia to reduce the possible risk of UI.

Intake of dietary flavonoids in relation to overactive bladder among U.S. adults: a nutritional strategy for improving urinary health.

The increasing influence of overactive bladder (OAB) on physical as well as mental health of individuals is becoming more pronounced annually, as evidenced by the urge urinary incontinence and nocturia. Symptoms in OAB patients may be influenced by inflammation and oxidative stress. Flavonoids are recognized as significant anti-inflammatory and antioxidant agents, which are commonly available in fruits, tea, vegetables, etc. Previous research has demonstrated the therapeutic potential of flavonoids and their subclasses in treating inflammation, and oxidative stress. Despite this, there remains a paucity of research exploring the potential correlation between flavonoid consumption, specifically within distinct subclasses, and OAB. Thus, our study aims to investigate the relationship between flavonoid intake and OAB to identify possible dietary interventions for OAB management. We utilized the survey data from the National Health and Nutrition Examination Survey (NHANES) and the USDA Food and Nutrient Database for Dietary Studies (FNDDS) to investigate the relationship between dietary intake of total and subclass flavonoids and the risk of OAB based on 13,063 qualified American adults. The dietary flavonoid intake was estimated from two 24-h dietary recalls. Weighted multivariate logistic regression model, quantile-based g-computation, restricted cubic spline model, and stratified analysis were used to explore the association between flavonoid intake and OAB, respectively. The participants diagnosed with OAB exhibited a higher percentage of being female, older, Non-Hispanic Black, unmarried, former drinkers, having a lower annual household income, lower poverty to income ratio, lower educational attainment, and a higher likelihood of being obese and smokers. Upon adjusting for confounding factors, the weighted logistic regression models revealed that the third quartile of consumption of anthocyanidin and the second quartile of consumption of flavone were significantly associated with the reduced odds of OAB, while total flavonoid consumption did not show a significant correlation with the risk of OAB. The quantile-based g-computation model indicated that flavone, anthocyanidin and flavonol were the primary contributors to the observed negative correlation. Furthermore, the restricted cubic spline models demonstrated a J-shaped non-linear exposure-response association between anthocyanidin intake and the risk of OAB (P nonlinear = 0.00164). The stratified and interaction analyses revealed that the relationship between anthocyanidin intake and the risk of OAB was significantly influenced by age (P interaction = 0.01) and education level (P interaction = 0.01), while the relationship between flavone intake and the risk of OAB was found to vary by race (P interaction = 0.02) and duration of physical activity (P interaction = 0.05). Our research suggests that consuming a diet rich in flavonoid subclass anthocyanidin and flavone is associated with a reduced risk of OAB, potentially offering clinical significance in the prevention of OAB development. This underscores the importance of dietary adjustments in the management of OAB symptoms.

Effects of external neuromuscular electrical stimulation in women with urgency urinary incontinence: a randomized sham-controlled study

Background and PurposeThe present study aims to investigate the effects of external neuromuscular electrical stimulation (NMES) on urinary symptoms, pelvic floor muscle strength (PFMS), quality of life (QoL), sexual function, perception of subjective improvement (PSI), and satisfaction in urgency urinary incontinence (UUI).Materials and MethodsThe randomized sham-controlled study design was employed in this study. Women aged 18–65 years, who were diagnosed with UUI, were randomly allocated into the NMES (external NMES + lifestyle advice, n = 15) and sham groups (sham NMES + lifestyle advice, n = 15). Both groups performed the application for 30 min, three days a week for eight weeks. Urinary symptoms were evaluated by using the International Incontinence Consultation Questionnaire-Short Form (ICIQ-SF) and a 3-day bladder diary. PFMS was assessed using the Modified Oxford Scale (MOS), QoL using the King’s Health Questionnaire (KHQ), and sexual function using the Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire (PISQ-12). The PSI and satisfaction were questioned.ResultsThere was a higher level of decrease in the ICIQ-SF score, the mean number of voids/night and UI, all scores related to the KHQ (excluding interpersonal relationships), and a higher level of increase in maximum voiding volume, MOS scores, PISQ-12-emotional, PISQ-12-physical, and PISQ-12-total scores in the NMES group when compared to the sham group (p < 0.05). PSI and satisfaction were at higher levels in the NMES group than in the sham group (p < 0.05).ConclusionsExternal NMES was an effective and complementary method in reducing urinary symptoms and improving PFMS, QoL, sexual function, PSI, and satisfaction level in women with UUI.Clinical Trial RegistrationNCT04727983.

Risk Factors of Pelvic Floor Disorders Among Women in Rural Nepal: A Case-Control Study.

Risk factors for pelvic floor disorders (PFDs) are not well understood in lower resource settings. The objective of this study is to determine the risk factors associated with stress urinary incontinence (SUI), urge urinary incontinence (UUI), and pelvic organ prolapse (POP) among women of reproductive age in rural Nepal. This is a case-control study nested within a community-based cross-sectional survey of parous women of reproductive age with PFDs in the Sarlahi District of Nepal. The presence of PFDs was confirmed by clinical assessment. Detailed sociodemographic information and histories were captured. We examined 406 women; the mean (SD, range) age was 32.7 (8.5, 16-49) years, mean BMI (SD) was 19.7 (3.3) kg/m2, and median (range) number of pregnancies was 4 (1-11). Two hundred and three women (50.0%) had either SUI or UUI, 85 (17.8%) had both SUI and UUI, and 71 (17.5%) had POP at or beyond the hymen. After controlling for other variables significant on bivariate analysis, age (adjusted odds ratio [aOR] 1.06 [95% CI 1.03-1.09]), illiteracy (aOR 2.24 [95% CI 1.04-4.80]), and presence of upper gastrointestinal issues (aOR 3.30, [95% CI 1.77-6.16]) were independently associated with SUI/UUI. Age (aOR 1.05 [95% CI 1.02-1.09]), bispinous diameter (aOR 2.88 ([95% CI 1.11-7.47]), and subpubic angle (aOR 2.78 [95% CI 1.55-5.03]) were independently associated with POP. Risk factors for PFDs in a homogenous community of parous women of reproductive age in rural Nepal are similar to those found in parous women in higher income countries.

Levator-urethra gap: is there a need for individualization of cut-offs?

To determine whether height, weight and body mass index (BMI) are associated with the levator-urethra gap (LUG) measurement, and whether these factors confound the relationship between LUG and symptoms and signs of pelvic organ prolapse (POP). This was a retrospective study of women seen at a tertiary urogynecology unit between January 2020 and December 2021. Postprocessing of saved ultrasound volume data was used to measure the LUG, blinded against all other data. This measurement was tested for its association with organ descent and hiatal area, and height, weight and BMI were investigated for any potential confounding effect. The 624 women seen during the inclusion period presented mostly with stress urinary incontinence (448/624 (72%)), urgency urinary incontinence (469/624 (75%)) and/or prolapse (338/624 (54%)). Mean age at assessment was 58 (range, 20-94) years, mean height was 163 (range, 142-182) cm, mean weight was 80 (range, 41-153) kg and mean BMI was 30 (range, 17-65) kg/m2. LUG measurements could be obtained in 613 women, resulting in 7356 (12 × 613) measurements. The average LUG in individual women measured 2.35 cm on the right and 2.32 cm on the left side (difference not significant), with a mean ± SD of 2.34 ± 0.63 cm overall. Mean LUG was associated with symptoms and signs of prolapse, both on clinical examination (POP quantification system) and on imaging, but not with height (P = 0.36), weight (P = 0.20) or BMI (P = 0.09). Levator-urethra gap measurements do not seem to be significantly associated with height, weight or BMI in our population, obviating the need for individualization of LUG. However, this does not exclude interethnic variability of this biometric measure. © 2024 International Society of Ultrasound in Obstetrics and Gynecology.

Two-year Pivotal Study Analysis of the Safety and Efficacy of Implantable Tibial Nerve Stimulation With eCoin for Urgency Urinary Incontinence

ObjectiveTo evaluate the continued effectiveness and safety of the eCoin Implantable Tibial Nerve Stimulator system (ITNS) for urgency urinary incontinence in patients with overactive bladder.The one-year pivotal study was extended through two years. The ITNS is a novel and recently FDA-approved therapy. MethodsA prospective, multicenter, single-arm trial was conducted on 137 subjects with refractory urgency urinary incontinence to evaluate eCoin ITNS therapy. A 3-day voiding diary was collected along with the overactive bladder questionnaire, Patient Global Impression of Improvement, and a custom Likert scale on subject satisfaction. The primary efficacy measure was the proportion of subjects who achieved at least 50% reduction from baseline in number of urgency urinary incontinence episodes. The primary safety measure was device-related adverse events. Results72 subjects completed the 96-week evaluation. 78% (95% CI: 67% - 87%) experienced at least 50% reduction in urgency urinary incontinence episodes; 48% (95% CI, 36%-60%) experienced at least 75% reduction, and 22% (95% CI, 13%-33%) were dry on a 3-day diary. Subjects reported a decrease from baseline in their urgency urinary incontinence episodes/day of 2.61 (SD 2.97) and 2.97 (SD 2.64) at 48 weeks and 96 weeks, respectively. 91.3% did not require additional medications for overactive bladder. No serious or unanticipated adverse events were reported in this extension phase. ConclusionsThe eCoin ITNS demonstrated consistent continuing effectiveness and safety in treating overactive bladder patients with urgency urinary incontinence. The findings support it as an excellent treatment option for refractory patients.

Lower Urinary Tract Symptoms, Toileting Behaviors, and Pelvic Floor Health Knowledge in Younger and Older Women.

The primary aim was to examine the relationship between lower urinary tract symptoms (LUTS), toileting behaviors, and pelvic floor health knowledge in younger and older women. The secondary aim was to compare LUTS, toileting behaviors, and pelvic floor health knowledge in younger and older women. The study included 85 younger women and 81 older women. LUTS were evaluated using the International Consultation on Incontinence Questionnaire-Female LUTS (ICIQ-FLUTS), toileting behaviors using Toileting Behavior-Women's Elimination Behaviors (TB-WEB), and pelvic floor health knowledge using the Pelvic Floor Health Knowledge Quiz (PFHKQ). In terms of LUTS, the most common symptoms in younger women are urgency (31.8%), bladder pain (28.2%), and frequency of incontinence episodes (35.3%), whereas in older women, the most common symptoms observed are urgency (64.2%), frequency of incontinence episodes (61.7%), intermittency (46.9%), urgency urinary incontinence (58%), and frequency of incontinence episodes (49.4%). Most unhealthy toileting behaviors correlated with LUTS in both groups (p < 0.05). Although a weak negative correlation was detected between ICIQ-FLUTS total score and PFHKQ function in younger women (p < 0.05), no correlation was found in older women (p < 0.05). Whereas premature voiding, straining during voiding, TB-WEB total score were higher in older women than in younger women (p < 0.05), delayed voiding, position preference for voiding, and PFHKQ function/dysfunction scores were higher in younger women than in older women (p < 0.05). Within the scope of preventive health services, it may be important to provide informative programs on healthy toileting behaviors and pelvic floor health to women of all ages in order to prevent LUTS.

The Effect of Kegel Exercises and Pelvic Floor Physiotherapy on the Improvements of Stress Urinary Incontinence and Urge Incontinence in Women with Normal Vaginal Delivery

Objectives: Pregnancy and normal vaginal delivery, are the main risk factors for urinary incontinence in women. A variety of treatments such as bladder training and pelvic floor exercises are effective for urinary incontinence. This interventional study has been conducted to compare the influence of Kegel exercises and pelvic floor physiotherapy on the improvements of urge and stress incontinence in women with first or second singleton pregnancies who have experienced normal vaginal delivery. Methods: One hundred fifty women with urinary incontinence in the postpartum period, who were divided randomly into 3 groups of 50 patients, participated in this prospective interventional study. The women were primigravida or it was their second labor. None of them complained of urinary incontinence before pregnancy. All of them had a normal vaginal delivery. The first group included females who were asked to perform Kegel exercises. The second group had 8 weekly physiotherapy appointments. The control group, included mothers who received routine care. We compared the prevalence of urge and stress incontinence between groups. Results: We found that the relative risk of urge and stress incontinence among mothers in the control group was more than in the intervention groups, but this difference was only statistically significant in the subject of stress incontinence between the Kegel and control groups. The reduction of urge incontinence prevalence among mothers in the Kegel and physiotherapy groups, was more than control group, although this reduction was not significant. Conclusion: There is a significant decrease in the prevalence of stress urinary incontinence at the end of the 8th and 12th weeks postpartum compared to the control group. Although the prevalence of urge incontinence among women in intervention groups was lower than in the control group, it was not significant. It seems the effect of Kegel exercises and pelvic floor physiotherapy, in reducing stress incontinence at the end of the 8th week, is almost equal.

The Effect of Eight-Week Kegel Exercise on Quality of Life in Postmenopausal Females with Urinary Incontinence

Introduction: Urinary incontinence (UI) is the leakage of urine which is often uncontrollable and can negatively impact on the quality of life (QoL). The aim of this study was to determine the effects of an eight-week of Kegel exercise as a complementary therapy on QoL in postmenopausal females with UI. Methods: The study design was a quasi-experimental pre-test post-test with a control group trial. The participants were Iranian women aged between 60 to 95 years with UI problems referring to medical centers in Najafabad city in Isfahan Province, Iran. Twenty four female UI patients were recruited and randomly divided into Kegel exercise (n = 12) and control group (n = 12). The Kegel group received exercise three times a week for eight-week, and the control group continued their routine life. The Questionnaire for Urinary Incontinence Diagnosis and the World Health Organization Quality of Life questionnaire were used for data collection. The variables were measured before and after the Kegel protocol in both groups. Descriptive statistics and analysis of covariance were used to assess variable differences between groups (p &lt; 0.05). Results: The mean age of UI patients was 70.83 ± 7.61 years old. Analysis of variance demonstrated a significant decrease in stress urinary incontinence symptoms (F = 61.88, p = 0.01), urge urinary incontinence symptoms (F = 111.56, p = 0.01), and UI symptoms (F = 88.20, p = 0.01), and significant increase in physical health (F = 28.93, p = 0.01), psychological health (F = 15.35, p = 0.01), social relationships (F = 18.83, p = 0.01), environment health (F = 155.51, p = 0.01), QoL (F = 132.07, p = 0.01) in Kegel exercise group. Conclusion: Kegel exercise can be an effective complementary therapy for improving QoL in postmenopausal female suffering from UI. Healthcare providers should consider recommending Kegel exercise as part of comprehensive treatment approach for postmenopausal female with UI to help alleviate symptoms and enhance their overall QoL.

Factors associated with persistent sexual dysfunction and pain 12 months postpartum

ObjectiveIdentify factors associated with persistent sexual dysfunction and pain 12-months postpartum in an underserved population. MethodsExtending Maternal Care After Pregnancy (eMCAP) is a program addressing health needs/disparities of patients at risk for worse perinatal outcomes. Participants completed the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) and Urinary Distress Index (UDI-6) 12-months postpartum. The PISQ-12 was dichotomized with scores < 32.5 indicating sexual dysfunction. Urinary incontinence (UI) was defined as at-least-somewhat bothersome (vs. none or not-at-all bothersome) urgency urinary incontinence (UUI) or stress urinary incontinence (SUI). Screening for anxiety and depression was completed using Generalized Anxiety Disorder-7 (GAD-7) and Edinburgh Postnatal Depression Scale (EPDS). Bivariate and multivariable logistic regression analyses were performed for sexual dysfunction vs. normal-function, and pain vs. no-pain, using demographic, peri/postpartum, and social-determinant-of-health variables as correlating factors. Results328 sexually active patients provided data. On bivariate analysis, sexual dysfunction (n = 31, 9.5%) vs. normal function (n = 297, 90.5%) groups showed no differences in age, BMI, parity, mode of delivery, episiotomy/laceration types, or breastfeeding. Sexual dysfunction was significantly associatedwith both UUI and SUI: 12 (39%) vs. 46 (15%) had UUI, p = 0.001, and 20 (65%) vs. 97 (33%) had SUI, P < 0.001; the dysfunction group also had higher GAD-7 and EPDS scores and greater overall stress levels. On multivariable analysis, SUI and stress remained significantly associated: OR (95% CI) 2.45 (1.02–6.03) and 1.81 (1.32–2.49), respectively. Comparing pain (n = 45, 13.7%) vs. no-pain (n = 283, 86.2%), dyspareunia patients endorsed greater stress levels. ConclusionThe interplay between sexual health, incontinence, and mental health deserves further study, and all three should be routinely addressed in postpartum care.

Association between the American Heart Association's new "Life Essentials 8" metrics and urgency urinary incontinence and nocturia.

Despite its widespread adoption in cardiovascular research, the application of LE8 in other health conditions, particularly urgency urinary incontinence (UUI) and nocturia, has not been thoroughly investigated. Our study used the Life's Essential 8 (LE8) score to evaluate the relationship between cardiovascular health (CVH) and urge urinary incontinence and nocturia in adults. This analysis utilized data from the National Health and Nutrition Examination Survey (NHANES) spanning 2011-2018. We used the LE8 score as the independent variable, and UUI and nocturia as the dependent variables. Multivariable logistic regression was conducted to explore the association between the LE8 score and the occurrence of UUI and nocturia. The study included 12,566 adults aged 20 and older. After adjusting for potential confounders, a higher LE8 score was inversely associated with the risk of UUI (OR = 0.38; 95% CI: 0.27-0.52, p < 0.0001) and nocturia (OR = 0.53; 95% CI: 0.44-0.65, p < 0.0001). This cross-sectional study revealed an inverse relationship between the LE8 score and the likelihood of both UUI and nocturia.

Urinary Incontinence Medications: Patient-Initiated Concerns in Primary Care.

Guideline-recommended medications for overactive bladder and urge urinary incontinence (OAB/UUI) are effective but have high costs and side effects. Little is known about patient concerns regarding these medications when prescribed by their primary care providers (PCPs). The aim of the study was to describe PCP-patient interactions when prescribing medications for OAB/UUI, specifically clinical concerns, cost and authorization issues, and mode of communication for these interactions. Using electronic health records, we identified a retrospective cohort of women aged 18-89 years who were prescribed a medication for OAB/UUI during a primary care office visit from 2017 to 2018. We examined the electronic health record from initial prescription through 15 subsequent months for documentation of prior authorization requests and patient concerns about cost, side effects, or ineffectiveness. The association of patient demographics, comorbidity, and medication class with these concerns was examined with logistic regression models. Overall, 46.2% of patients (n = 123) had 1 or more OAB/UUI medication concerns, and 52 reported outside an office visit. Only higher comorbidity was associated with reduced concern of any type. Although the overall percent age of patients reporting concerns was similar by medication type, the patterns of concern type varied. Compared with those taking short-acting antimuscarinics, patients taking long-acting antimuscarinics other than oxybutynin were less likely to have side effect concerns (adjusted odds ratio 0.35, 95% CI 0.16-0.78) and more likely to have cost concerns (adjusted odds ratio 5.10, 95% CI 1.53-17.03). Patient concerns regarding OAB/UUI medications were common in primary care practices and frequently reported outside of office visits. However, the patterns of concerns (cost vs side effects) varied between medication classes.

Long-term sexual function after mid-urethral slings for stress urinary incontinence in women.

There has been increasing concern about potential negative impact of mid-urethral slings (MUS) on sexual life. Our aim was to study sexual activity 10-20 years after MUS surgery and changes in impact of incontinence on sexual life over time and to compare subjective cure, pain, satisfaction, and incontinence between sexually active and inactive women 10-20 years after MUS. Historical cohort study using the Norwegian Female Incontinence Registry to identify women who underwent MUS between 2001-2006 and 2011-2012. They answered validated questionnaires about sexual activity, incontinence, pain, and satisfaction with MUS. We assessed changes in urinary incontinence during intercourse and compared symptoms and satisfaction between sexually active and inactive women. The study was registered in Clinical Trials (NCT04912830). In total, 1210/1903 (64%) responded. Of women responding to questions about sexual activity, 63% (735/1166) were sexually active. 31.3% experienced negative impact of incontinence on sexual life preoperatively, decreasing to 5.9% at 10-20 years follow-up. A higher proportion of sexually inactive vs sexually active women had urinary incontinence (63.5% vs. 47.5%, aOR 1.60 [1.18-2.17]). In a subanalysis, only urgency and mixed urinary incontinence remained significant. A higher proportion of sexually inactive were dissatisfied with MUS (30.1% vs. 12.9%, aOR 2.53 [1.82-3.51]). Persistent pain after MUS was similar for sexually inactive and active women (4.0% vs. 3.2%, aOR 1.10 [0.55-2.19]). Furthermore, 3.4% of sexually inactive had persistent pain after MUS and stated pain as a reason for not being sexually active, whereas 1.7% of sexually active women had persistent pain after MUS and pain during intercourse. Negative impact of incontinence on sexual life was less prevalent at 10-20 years follow-up after sling surgery compared to preoperative assessment. A higher proportion of sexually inactive had urgency and mixed urinary incontinence and were dissatisfied with MUS. Only 3%-4% of sexually active and inactive women had persistent pain after MUS and this was not associated with sexual activity. This indicates that incontinence has a greater negative impact on sexual activity than persisting pain after MUS at long-term follow-up.

Comparison of HoLEP, ThuLEP and ThuFLEP in the treatment of benign prostatic obstruction: a propensity score-matched analysis.

To compare the efficacy and safety of Holmium laser enucleation of the prostate (HoLEP), Thulium laser enucleation of prostate (ThuLEP) and Thulium fibre laser enucleation of prostate (ThuFLEP) by performing propensity score matched analysis (PSM). We retrospectively analysed the patients who underwent HoLEP (Group 1, n = 696), ThuLEP (Group 2, n = 146) and ThuFLEP (Group 3, n = 193) surgery because of benign prostatic obstruction (BPO). A 1:1:1 HoLEP: ThuLEP: ThuFLEP group matching was performed using PSM analysis. Perioperative, postoperative functional outcomes and complications were analysed and compared. We observed significant improvement in functional parameters regarding IPSS, Qmax, PVR and quality of life in all groups compared to baseline values at the 1st, 6th and 12th postoperative months. There was no significant difference between different laser types in terms of urge (UUI) and stress urinary incontinence (SUI) at 1st postoperative month. In all three groups, no patient had postoperative SUI or UUI at 6th and 12th postoperative months. In addition, no significant difference was observed between laser types in terms of postoperative complications. HoLEP, ThuLEP and ThuFLEP are safe and effective LEP methods with improvement in functional parameters and low complication rates. Similar results in terms of functional outcomes and complications clearly show that these surgeries are alternatives to each other for the patients with BPO. Experts' opinions, practices and enucleation techniques should also be taken into consideration when choosing a laser for BPO surgery.

Overactive bladder and cognitive impairment in middle-aged women: A cross-sectional study

BackgroundOveractive bladder (OAB) is a common condition in middle-aged and older women. It has been reported to be potentially linked to cognitive decline, particularly in older adults. This study investigated the association between OAB symptoms and cognitive impairment in middle-aged women. Materials and methodsThis cross-sectional study had a sample of 1652 women (mean age 49.3 ± 2.8 years) who were not taking medication for either urinary tract infection or OAB. OAB symptoms and cognitive function were evaluated by self-administered questionnaires: the Overactive Bladder Symptom Score and the Alzheimer's disease 8. Logistic regression models estimated prevalence ratios (PRs) with 95 % confidence intervals (CI) for cognitive impairment according to the presence/absence of OAB. Mediation analyses assessed the impact of poor sleep quality on this association. ResultsCognitive impairment was more prevalent in women with OAB than in those without OAB (multivariable-adjusted PR: 1.88 [95 % CI: 1.52–2.24]). Women experiencing nocturia (≥twice a night), urinary urgency at least once a week, and urgency urinary incontinence at least once a week had multivariable-adjusted PRs (95 % CI) for cognitive impairment of 2.08 (1.50–2.65), 2.12 (1.66–2.58), and 1.75 (1.17–2.34), respectively. Poor sleep quality mediated 10.81 % [95 % CI: 4.55–19.44 %] of the relationship between OAB and cognitive impairment. ConclusionsAmong middle-aged women not taking OAB medications, OAB symptoms were associated with cognitive impairment, partly because of poor sleep quality. Further research is needed to determine whether early screening of patients with OAB can help identify those susceptible to cognitive impairment associated with OAB medication and if preventive measures should be targeted at this group.