Urinary Incontinence Short Form Research Articles

Urogynecological symptoms and pelvic floor muscle tender points in women with and without fibromyalgia

Aims: To compare the urinary, sexual and vaginal symptoms frequency, pelvic floor muscles (PFM) tender points and pain severity in women with and without fibromyalgia. Methods: Cross-sectional study composed by women with fibromyalgia (FMG) and without it (control group, CG) assessed by: (a) sexual (Female Sexual Function Index - FSFI); (b) vaginal (International Consultation on Incontinence Questionnaire ICIQ-Vaginal Symptoms); (c) urinary (ICIQ: Urinary Incontinence Short Form ICIQ-UI SF and ICIQ-Overactive Bladder ICIQ-OAB); (d) quality of life (King’s Health Questionnaire - KHQ), as well as digital palpation assessment of: tone (normal, increased or decreased); tender points (position by clock-face); and pain severity (numeric rating scale - NRS). Statistical analysis included Student’s t-test, Wilcoxon-Mann-Whitney’s, logistic Regression and Spearman’s Correlation (significance level: 5%). Results: Of the 84 women enrolled, 39 FMG and 39 CG completed the study. No differences in urinary or vaginal symptoms were found. FMG presented lower FSFI (FMG: 7.2; CG: 21.6; p<0.001), more PFM tender points (FMG: 10 (25.6%); CG: 1 (2.6%); p=0.03), greater quality of life impairment (FMG: 5, CG: 4; p=0.01) and sleep/energy (FMG: 5, CG: 2, p<0.01) both KHQ domains. The pain severity was FMG: 4 (1-6); CG: 7(7); p=0.05. Conclusion: More PFM tender points, greater impairment in sexual function, as well as in quality of life were all more frequent in women with fibromyalgia when compared to healthy controls. However, the correlation between sexual function and PFM pain was low.

Telehealth exercise for continence after gynaecological cancer treatment (TELE-CONNECT): a protocol for a co-designed pragmatic randomised controlled trial

BackgroundUrinary incontinence (UI) is the most prevalent pelvic floor disorder following treatment for gynaecological cancer with a distressing impact on quality-of-life in survivors. Physiotherapist-supervised pelvic floor muscle (PFM) training is recommended as the first-line intervention for UI in community-dwelling women. However, it is not known if this intervention is effective in women following treatment for gynaecological cancer, nor whether PFM training can be delivered entirely remotely. The primary aim of this study is to investigate if a telehealth-delivered PFM training program incorporating a novel biofeedback device reduces UI compared with usual care, following gynaecological cancer.MethodsThis is a pragmatic, two-arm parallel-group, stratified superiority randomised controlled trial recruiting 72 participants (ACTRN12622000580774). Recruitment sites include gynaecology-oncology outpatient clinics, supplemented by advertisements through community foundations/social media/care groups. Participants must have completed primary cancer treatment at least 6 months prior or adjuvant therapy at least 3 months prior, for Stage I, II or III uterine, cervical, fallopian tube, primary peritoneal or ovarian cancer or borderline ovarian tumour, and have UI occurring at least weekly. Participants randomised to the usual care group will receive bladder and bowel advice handouts and one audio telehealth physiotherapist consultation to answer any queries about the handouts. Participants randomised to the intervention group will receive the same handouts plus eight video telehealth physiotherapist consultations for PFM training with a biofeedback device (femfit®), alongside a home-based program over 16 weeks. The primary outcome measure is a patient-reported outcome of UI frequency, amount and interference with everyday life (measured using the International Consultation on Incontinence Questionnaire – Urinary Incontinence Short Form), immediately post-intervention compared with baseline. Secondary outcomes include quality-of-life measures, bother of pelvic floor symptoms, leakage episodes, use of continence pads and global impression of change. We will also investigate if the intervention improves intra-vaginal resting and squeeze pressure in women in the intervention arm, using data from the biofeedback device.DiscussionIf clinical effectiveness of telehealth-delivered physiotherapist-supervised PFM training, supplemented with home biofeedback is shown, this will allow this therapy to enter pathways of care, and provide an evidence-based option for treatment of post-cancer UI not currently available.Trial registrationAustralian New Zealand Clinical Trials Registry (ANZCTR), ID 12622000580774. Registered 20 April 2022.

Body image and pelvic floor dysfunction in pregnancy and postpartum: A prospective one-year follow-up cohort study.

To determine the prevalence of pelvic floor dysfunction (PFD) among pregnant women, their clustering and their association with body image disturbance (BID) up to 1 year postpartum. Monocentric prospective cohort study. University Hospitals Leuven. Pregnant women attending for pregnancy care, first assessed prior to 14 weeks of gestation and agreeing to follow-up until 1 year postpartum. Standardised questionnaires reporting on PFD and BID at 12-14 and 28-32 weeks of gestation, and again at 6-8 weeks and 1 year postpartum. We calculated the prevalence of PFD, how the cases clustered and how the cases correlated with BID using a linear mixed-model analysis. A minimum of 174 women with complete follow-up were required. The questionnaires used were the International Consultation on Incontinence Questionnaire - Urinary Incontinence Short Form (ICIQ-UI SF), St. Mark's Incontinence Score (SMIS), Patient Assessment of Constipation Symptoms (PAC-SYM), Pelvic Organ Prolapse Distress Inventory (POPDI), Pelvic Organ Prolapse/Incontinence Sexual Questionnaire IUGA Revised (PISQ-IR) and the Body Image Disturbance Questionnaire (BIDQ). Out of 208 women, 92.8% reported one or multiple symptoms of PFD at 28-32 weeks of gestation, dropping to 73.6% by 1 year postpartum. The most common symptoms were constipation (65.3% at 28-32 weeks of gestation and 42.8% at 1 year postpartum) and urinary incontinence (56.8% at 28-32 weeks of gestation and 35.1% at 1 year postpartum). After correcting for body mass index, parity and mode of delivery, the severity of BID was associated with the ICIQ-UI SF score (β = 0.016, range 0.007-0.024), the PAC-SYM score (β = 0.006, range 0.002-0.011) and the POPDI score (β = 0.009, range 0.005-0.012), but not with the SMIS score (β = 0.015, range -0.001 to 0.031) or the PISQ-IR score, in sexually active women. Urinary incontinence, constipation and symptoms of prolapse have a measurable impact on BID.

The effect of the distance between mesh and the urethra on sexual function in patients who underwent transobturator tape

To evaluate the effect of mesh-urethra distance on sexual function in continent patients who underwent transobturator tape (TOT) surgery due to isolated stress urinary incontinence (SUI). Continent patients who had undergone TOT surgery for SUI were eligible. Objective treatment for SUI was defined as the absence of urine leakage during a stress test. Translabial perineal ultrasound was performed six months after surgery. The successful surgical group was split into two subgroups based on the distance from the posterior of the urethra at the bladder neck to the nearest proximal edge of the tape: <5 mm and >5 mm. In addition to these, band percentile, the descent of bladder neck and urethra length measured by perineal ultrasound, pubo-urethral distance, urethral thickness, detrusor thickness, cystocele descent, rectal descent, and uterine descent were evaluated. Preoperative and postoperative results of the standardized and internationally valid incontinence questionnaires Incontinence Questionnaire Urinary Incontinence Short Form and Female Sexual Function Index (FSFI) were compared between groups. Eighty-two patients were included. The postoperative FSFI scores for the >5 mm group were significantly lower than those of the <5 mm group, including the postoperative FSFI average, all subscales except lubrication, and average change scores due to the operation (p<0.001). There was no statistically significant relationship between the percentile occupied and postoperative FSFI score (p=0.553), and the FSFI preoperative-postoperative difference was not significant (p=0.905). Sexual functions are more affected in patients with a mesh-urethra distance >5 mm as measured by perineal ultrasound.

Impact of Lifestyle on Urinary Incontinence Severity among Women: A Cross-Sectional Study in East China.

Identifying the factors influencing the development of female urinary incontinence (UI) may facilitate early intervention, potentially delaying its progression. This study was aimed at investigating the impact of lifestyle habits on the severity of UI among women in East China. This study included 414 women from six communities in East China who reported symptoms of UI and was conducted between September and December 2020. Data were collected using a general information questionnaire, the Toileting Behaviours: Women's Elimination Behaviours scale, and the International Consultation on Incontinence Questionnaire Urinary Incontinence Short Form Chinese Version. Participants were categorised into two groups: those with mild UI and those with moderate-to-severe UI. Propensity-score matching was performed to balance confounding factors, and logistic regression was used to explore the relationship between lifestyle behaviours and UI severity. A total of 117 pairs were successfully matched. Logistic regression analysis revealed that daily perineal cleaning significantly protected against moderate-to-severe UI (p < 0.05). Conversely, living alone, poor sleep quality and hovering over the toilet while voiding were identified as independent risk factors for moderate-to-severe UI (p < 0.05). Several lifestyle habits significantly impact the severity of UI among adult women. Screening for mild urinary leakage symptoms and implementing timely interventions are crucial for preventing the aggravation of UI and improving ability to work and quality of life.

Pelvic Floor Muscle Training on Stress Urinary Incontinence in Power- and Weightlifters: a Pilot Study

Introduction and hypothesisStress urinary incontinence (SUI) is defined as involuntary leakage of urine on physical effort and is prevalent among power- and weightlifters. However, there is scant knowledge on treatment options for this population. The aim of this pilot study was to evaluate the potential outcomes and feasibility of a pelvic floor muscle training (PFMT) program on SUI in nulliparous female power- and weightlifters.MethodsThis was a case-series study, including one weightlifter and two powerlifters aged 21–32 years. The participants conducted 12 weeks of PFMT at home, with weekly follow-up by a physiotherapist. Change in total score of the International Consensus of Incontinence Questionnaire Urinary Incontinence Short Form (ICIQ-UI-SF) was the primary outcome. Secondary outcome was perceived change assessed by the Patient Global Impression of Improvement (PGI-I) Scale and impact on sport participation. PFM strength, endurance, and resting pressure was measured using vaginal manometry. Feasibility was evaluated as adherence to training and self-efficacy (Self Efficacy Scale for Practicing Pelvic Floor Exercises).ResultsOne athlete reduced their ICIQ-UI-SF score and experienced improvement in symptoms. One athlete reported no change, and one reported a worsening of symptoms. All three participants improved PFM strength and endurance, completed the testing, and 12 weeks of PFMT, but adherence varied between 40 and 80%. Participants reported a lack of time and energy and forgetting to perform the exercises, as reasons for low adherence.ConclusionThere were varying effects of a 12-week PFMT program on SUI in three strength athletes. The results can create the basis for a future randomized controlled trial.

Urinary incontinence among Jordanian women: Prevalence, types, and associated factors

ObjectiveUrinary incontinence (UI) is a prevalent condition with a negative impact on women's quality of life. Data about UI among Jordanian women are lacking; therefore, we aimed to investigate the prevalence, types, and associated factors. MethodsA cross sectional nationwide survey was conducted between 1 March 2020 and 15 April 2020. Women were included if they were 18 years of age or more and had access to the internet. Data collected included women's characteristics, UI types, and associated factors. UI was inventoried by asking women if they have UI (yes/no), and the Arabic language validated International Consultation on Incontinence Questionnaire Urinary Incontinence-Short Form was used. Age-group specific prevalence rates of UI were estimated, and associated factors were studied using logistic regression analyses. ResultsData from 2118 women were analysed. Median age was 40 (range 18–85) years, 58.3% gave birth three or more times, and 64.1% consistently reported having UI. Limited mobility and being multiparous increased the likelihood of reporting UI. Compared to women with normal body mass index, overweight and obese women were 1.9 times and 4.4 times more likely to report UI, respectively. ConclusionThe prevalence of UI among Jordanian women is 64.1%, with mixed UI and stress UI being the more prevalent types in women younger than 60 years old. Age, parity body mass index, and limited mobility are all associated factors with UI. The results of this study provide healthcare policy makers with the necessary information to increase awareness and knowledge regarding UI.

Utility of opportunistic screening to assess the impact of urinary incontinence on quality of life and barriers to seeking treatment among women attending a tertiary healthcare centre in North India

IntroductionUrinary incontinence (UI) is a common but frequently neglected problem in females, significantly impacting their psychosocial health. The available estimates are an underestimation of a bigger problem. Thus, the study aimed to estimate the prevalence of UI, its associated risk factors, its impact on the Quality of life (QoL), and barriers to treatment-seeking behaviour in women attending tertiary healthcare centres.MethodsWe conducted a cross-sectional study using an opportunistic screening among women visiting a tertiary care hospital in Punjab recruited using multi-stage systematic random sampling. UI was classified as Stress (SUI), Urge (UUI), mixed (MUI), and No Incontinence (UI less than once a week or a month or no complaints) using the International Consultation on Incontinence Questionnaire–Urinary Incontinence Short Form (ICIQ-UI SF). Bivariate analyses were done using the chi-square test to test the association between the dependent and independent variables. The predictors of UI were explored using univariable and multivariable binary logistic regression and depicted using Odds ratio with 95% confidence intervals. The impact of UI on Quality of Life (QoL) was assessed using the Incontinence Impact Questionnaire-Short Form (IIQ-7), and compared among the three UI types using One-Way ANOVA. Treatment barriers were explored using open-ended questions.ResultsOf the 601 women, 19.6% reported UI (stress UI: 10.1%, mixed UI: 6.0%, and urge UI: 3.5%). There were significant clinical-social factors that predicted different types of UI. The UI depicted a significant effect on QoL across all domains of the IIQ-7 (total mean score: 50.8 ± 21.9) compared to women with no incontinence (0.1 + 1.9). The score was highest in women with MUI, followed by SUI and UUI. About two-thirds of the affected women never consulted a doctor and considered it a non-serious condition or a normal ageing process.ConclusionsThe present study found a high prevalence of UI through opportunistic screening across all the women’s age groups with different conditions. Due to the associated stigma, clinicians should make every attempt to talk more about this, especially in women with medical conditions that can precipitate UI. Furthermore, the results call for generating more robust estimates through community-based screening studies.

Association of Urinary Incontinency with COPD Severity: An Analytical Cross-sectional Study

Large number of patients suffers from urinary incontinence (UI) with COPD leading to urine leakage and affecting their quality of life. Objective: To determine the prevalence and association of UI among with the severity of COPD patients. Methods: The cross sectional study was conducted from February 2023 to June 2023 in Ghurki Teaching Trust Hospital, Shalimar Hospital and Gangaram Hospital. 230 male patients of age 45-65 years suffering with COPD were selected by using convenient sampling technique. The demographic data and International Consultation on Incontinence Questionnaire- Urinary Incontinence Short Form (ICIQ-UI SF) were used collected. SPSS version 26.0 along with Chi-square was used for analysis with p-value &lt;0.05. Results: The results showed that 36 (15.7%) suffering with mild COPD, 142 (61.7%) had moderate COPD and 52 (22.6%) had severe COPD in which 33 (14.3%) experience have no urine incontinency, 25 (10.9%) had urge Incontinence, 154 (67%) had stress Incontinence and 18 (7.8%) had mixed Incontinence. Additionally; moderate COPD had shown significant association with stress incontinency with Chi-square value of 188.58 and p-value =0.00 and with the leakage of urine on coughing/ sneezing, during any physical activity/ exercise and all the time with value of 143.37, p-value = 0.00. Conclusions: The study concluded that UI is highly prevalent in COPD patients as stress and urge incontinency is highly prevalent among moderate and severe patients respectively, associated with coughing/ sneezing and physical activity/ exercises.

Effects of Electrical Stimulation, Pelvic Floor Muscle Exercise, and Biofeedback Program on Improving Pelvic Floor Function and Quality of Life in Postoperative Patients with Early-Stage Cervical Cancer.

Pelvic floor muscle exercise (PME), biofeedback, and electrical stimulation improve pelvic floor function, but the effect of their combination in patients with early-stage cervical cancer is unclear. This study intended to design a combined intervention encompassing these three interventions and explore its effect on pelvic floor function in postoperative patients with early-stage cervical cancer. Totally, 177 postoperative patients with early-stage cervical cancer were assigned to combination (N = 81) and PME (N = 96) groups according to actual interventions. Pelvic Floor Distress Inventory-Short Form 20 (PFDI-20), International Consultation on Incontinence Questionnaire Urinary Incontinence Short Form (ICIQ-UI-SF), and EORTC Core Quality of Life questionnaire (EORTC QLQ-C30) scores were assessed at the seventh day after surgery (W0), and at 4 (W4), 8 (W8), and 12 (W12) weeks after W0. PFDI-20 scores at W8 (P = 0.042) and W12 (P = 0.006), and ICIQ-UI-SF scores at W4 (P = 0.012), W8 (P = 0.024), and W12 (P = 0.003) were lower in the combination group versus PME group. PFDI-20 decline and ICIQ-UI-SF decline (W0-W12) were greater in the combination group versus PME group (both P = 0.007). Combined intervention (versus PME) was independently related to greater PFDI-20 decline (B = 5.548, P < 0.001) and ICIQ-UI-SF decline (W0-W12) (B = 1.544, P = 0.006). EORTC QLQ-C30 global health status scores at W12 were higher in the combination group versus PME group (P = 0.045), while EORTC QLQ-C30 function and symptom scores at any time points were not different between the two groups (all P > 0.05). Combined intervention achieves greater pelvic floor function improvement and better quality of life compared to PME in postoperative patients with early-stage cervical cancer.

Flat Magnetic Stimulation for Urge Urinary Incontinence.

Background and Objectives: Strategies for overactive bladder syndrome (OAB) management involve, among others, strengthening the bladder outlet to suppress urgency and neuromodulating the sacral roots. Magnetic stimulation (MS) is a technology that involves an extracorporeal device that is able to provide an electromagnetic field specifically designed to interact with pelvic floor neuromuscular tissue. The resulting tissue electrical activity induces contraction of the pelvic muscle and neuromodulation of the S2-S4 sacral roots. Flat Magnetic Stimulation (FMS) is a relevant advancement involving homogeneous electromagnetic fields, which are able to optimize the effect on the entire pelvic area. However, the benefits of this new technology for OAB syndrome are poorly known. Consequently, the aim of our study is to analyze the outcomes and quality of life (QoL) impact of FMS with Dr. Arnold (DEKA, Calenzano, Italy) in women suffering from OAB syndrome associated with urinary incontinence. Materials and Methods: This prospective study included patients with OAB, urge urinary incontinence, and no ongoing OAB treatments. At baseline (T0), the Incontinence Impact Questionnaire (IIQ-7), the Female Sexual Function Index (FSFI-19), and the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) were collected. Patients underwent 8 FMS sessions of 25 min each in one month. At the termination of the therapy (T1), women repeated the ICIQ-UI SF, FSFI-19, and IIQ-7 tools. Moreover, the Patient Global Impression of Improvement (PGI-I) questionnaire was collected to evaluate the cure rate. Results: Our study enrolled a total of 57 consecutive patients. Most women had at least one second- or third-line treatment before FMS, while the remaining naive patients had contraindications to pharmacological treatments. No women reported adverse effects during the treatment. After the treatment, we observed a decrease in the IIQ-7 (p < 0.001) and ICIQ-UI SF scores (p < 0.001) and an improvement in sexual function (p < 0.001) evaluated with FSFI-19. According to PGI-I scores, 42 (73.7%) women referred to some kind of improvement, scoring ≤ 3 points. Specifically, 8.7% of patients considered themselves very much improved, 29.8% much improved, 35.1% minimally improved, and 26.3% found no changes. FMS was effective in treating OAB symptoms without any adverse effects. The mechanism is supposed to be related to suppressing the initiation of micturition. This makes FMS a promising device for treating naive and refractory urge urinary incontinence. Conclusions: The new FMS represents a promising non-pharmacological option for the treatment of naive and refractory OAB.

Use of Fermented Red Clover Isoflavones in the Treatment of Overactive Bladder in Postmenopausal Women: A Randomized, Double-Blinded, Placebo-Controlled Trial.

Postmenopausal women are at risk of developing an overactive bladder (OAB). Conventional vaginal estrogen has shown promise for symptom relief. Isoflavones have proven effective as an alternative to estrogen treatment against menopause-related symptoms. However, its effect on OAB symptoms has not been studied. This study investigates if fermented red clover isoflavones reduce OAB symptoms in postmenopausal women. In this randomized, double-blinded, placebo-controlled trial, women were administered red clover extract (RCE) or a placebo twice daily for three months. Women filled out the International Consultation on Incontinence Questionnaire Overactive Bladder (ICIQ-OAB) and Urinary Incontinence Short Form (ICIQ-UI-SF), together with a fluid intake and voiding diary. A total of 33 women (16 in the RCE group and 17 in the placebo group) were included in the analysis. Baseline demographics and OAB characteristics were comparable across groups. Intake of RCE did not lead to significant relief in most urinary bladder symptom measures, although a significant reduction in the bother of urinary urgency (p = 0.033) and a tendency towards a decreased ICIQ-OAB score were observed (p = 0.056). In contrast, the placebo exhibited a significant decrease in the ICIQ-OAB score (p = 0.021) and in some diary outcomes. We found that an intake of isoflavones did not relieve OAB symptoms in postmenopausal women.

Optimizing remote access to urinary incontinence treatments for women veterans (PRACTICAL): Study protocol for a pragmatic clinical trial comparing two virtual care options

ObjectivesIn this pragmatic clinical trial, the primary objective is to increase access to behavioral treatment of urinary incontinence (UI) for women Veterans by comparing the effectiveness of two virtual care delivery modalities. MethodsVeterans Affairs (VA) clinical sites in AL, GA, NC will virtually randomize 286 women Veterans with UI (ie, stress, urge, or mixed). We will compare the effectiveness of our mHealth UI application (MyHealtheBladder) to a single VA Video Connect (VVC) session delivered by trained UI providers. Women without improvement after 8 weeks will receive an optimization VVC visit using a sequential, multiple assignment, randomized trial (SMART) design. The primary outcome is UI symptom improvement at 12-weeks with or without optimization; secondary outcomes include improvements in lower urinary tract symptoms, adherence, retention rates, perceptions of improvement, and visit-related miles saved. Sample size needed to identify a 2.5-point change (range 0–21) in the International Consultation on Incontinence Questionnaire – Urinary Incontinence Short Form (ICIQ-UI SF) from baseline to 12-weeks post-randomization is 200 participants. Allowing for an attrition rate of 25%, 286 participants are required. Key resultsStudy team initiated remote recruitment on April 2020. Recruitment is on target with a 75% retention rate. We expect completion in fall of 2023 (clinicaltrials.govNCT04237753). Discussion/ConclusionEngaging women Veterans with virtual modalities for initial UI treatment may increase access to UI care while also improving symptoms. After assessing efficacy, adherence, and retention, the next step is to implement the most effective option for remote delivery of evidence-based behavioral UI treatment for women Veterans.Trial registration:ClinicalTrials.gov number NCT04237753

Mucomucosal anastomotic non-transecting augmentation (MANTA) urethroplasty: a ventral modification for obliterative strictures.

To present a surgical modification for the repair of bulbar urethral strictures containing short, highly obliterative segments and report on long-term objective and patient-reported outcomes. We considered patients undergoing bulbar buccal mucosal graft urethroplasty (BMGU) between July 2016 and December 2019. Eligibility criteria for mucomucosal anastomotic non-transecting augmentation (MANTA) urethroplasty were strictures of ≥2 cm with an obliterative segment of ≤1.5 cm. The stricture is approached ventrally to avoid extensive dissection and mobilisation. Dorsally, the scar is superficially excised and the spongiosum is left intact. Dorsal mucomucosal anastomosis is complemented by ventral onlay graft. Perioperative characteristics were prospectively collected including uroflowmetry data and validated patient-reported outcome measures on voiding, erectile, and continence function. We evaluated functional follow-up, incorporating patient-reported (lower urinary tract symptoms [LUTS] score) and functional success. Recurrence was defined as need of re-treatment. Of 641 men treated with anterior BMGU, 54 (8.4%) underwent MANTA urethroplasty. Overall, 26 (48%) and 45 (83%) had a history of dilatation and urethrotomy, respectively, and 14 (26%) were redo cases. Location was bulbar in 38 (70%) and penobulbar in 16 patients (30%), and the mean (SD) graft length was 4.5 (1.4) cm. At a median (interquartile range) follow-up of 41 (27-53) months, the functional success rate was 93%. Whereas the median LUTS score significantly improved from baseline to postoperatively (13 vs 3.5; P < 0.001), there was no change in erectile function (median International Index of Erectile Function - erectile function domain score 27 vs 24) or urinary continence (median International Consultation on Incontinence Questionnaire - Urinary Incontinence Short Form sum score 0 vs 0; all P ≥ 0.4). All patients were 'satisfied' (27%) or 'very satisfied' (73%) with the outcome of their operation. With excellent long-term objective and patient-reported outcomes, MANTA urethroplasty adds to the armamentarium for long bulbar strictures with a short obliterative segment.

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

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

Prevalence of pelvic floor dysfunction in recreational athletes: a cross-sectional survey.

Pelvic floor dysfunction (PFD) affects many women and participation in elite sport and high-impact exercise has been reported as a potential risk. However, few studies have investigated the effects of exercising at recreational levels on PFD. Our aim was to investigate levels of PFD in women exercising at, or above, UK guidelines for health and compare them with levels in non-exercisers. Data on levels of PFD and potential risk factors (age, hormonal status, body mass index, constipation, parity, forceps delivery, and recreational exercise) were collected using a cross-sectional survey distributed via social media. The International Consultation Incontinence Questionnaire (ICIQ) Urinary Incontinence Short Form was used to estimate prevalence of urinary incontinence (UI). Selected questions from the ICIQ vaginal symptom and bowel symptom questionnaires were used to estimate prevalence of anal incontinence (AI) and pelvic organ prolapse (POP). Logistic regression analysis was used to compare exercisers and non-exercisers after adjusting for potential confounders. We recruited 1,598 adult women (1,141 exercisers and 457 non-exercisers). The majority were parous. High prevalence of UI (70%), AI (52%) and POP (18%) was reported. No significant association was found between recreational exercise and PFD despite adjustment for confounders, or further investigation regarding exercise involving impact, although some increased reporting of AI was seen in those exercising for over 10hoursper week. High levels of all PFD were reported but no significant association was found between recreational exercise and symptoms. However, data suggest that women modify their exercise regimes as required. Few symptomatic women sought professional help.

Effects of ospemifene on overactive bladder in postmenopausal women with vulvovaginal atrophy

Objective Overactive bladder (OAB) is a complex and multifactorial syndrome associated with urinary frequency, urgency and incontinence. The menopause-associated hormonal changes play a role in the development of this condition. Vaginal estrogens are effective in improving OAB in postmenopausal women (PMW) with vulvovaginal atrophy (VVA). Ospemifene is a selective estrogen receptor modulator licensed for the treatment of VVA. This study aimed to evaluate the effects of ospemifene on OAB symptoms in PMW with VVA. Methods Forty PMW suffering from OAB and VVA received oral ospemifene (60 mg/day) for 12 weeks. All patients were assessed with a urodynamic study, a 3-day bladder diary and validated questionnaires (International Consultation on Incontinence Questionnaire – Urinary Incontinence Short Form [ICIQ-UI SF] and International Consultation on Incontinence Questionnaire – Overactive Bladder [ICIQ-OAB]) at enrollment and at the end of the study. Results Cytometric capacity, bladder compliance and verbal sensory threshold responses during bladder filling were improved after treatment. The voiding diary showed a significant reduction of daily voids, urge urinary incontinence episodes and nocturnal events. The median overall scores of the ICIQ-UI and ICIQ-OAB were also significantly improved. Conclusions Our study suggest that treatment with ospemifene in PMW suffering from OAB is associated with a reduction of OAB symptoms due to a decreased bladder sensitivity and with an improvement in quality of life.

EFFICACY OF POLYACRYLAMIDE HYDROGEL FOR FEMALE URINARY INCONTINENCE: OUTCOME OF A SINGLE CENTRE

Introduction: Periurethral injection with polyacrylamide hydrogel (PAHG, Bulkamid®) is a minimally invasive treatment option to be considered for women with stress urinary incontinence. The manufacturer recommends injecting between 1.5 ml and 2 ml periurethrally. This study aims to evaluate the long-term efficacy of PAHG, and to determine whether there is a correlation between the volume of PAHG injected and the outcome in terms of symptoms. Methods: A retrospective study was conducted between 2011 and 2018. Patients were contacted by telephone and the International Consultation on Incontinence Questionnaire – Urinary Incontinence Short Form (ICIQ-UI SF) was used to assess their symptoms. A linear regression analysis test was performed to assess the correlation between the outcome and the volume of PAHG injected. Results: One hundred and fifteen PAHG injections were performed on 101 patients. The volume of PAHG injected ranged from 0.8 ml to 3 ml. Two patients reported procedure-related complications. Of the patients that attended their three-month follow-up, 62 (58.5%) patient-episodes reported an improvement. 62 patients were contacted by telephone and the median length of follow-up was 37.5 months. An improvement in the ICIQ-UI SF score was observed in 45.8% of patients with a mean improvement of 4 points. The volume of PAHG injected did not affect the outcome. 31% also reported a benefit with PAHG five years after their injection following previous incontinence surgery. Conclusions: PAHG injection is safe and improves symptoms of urinary incontinence at up to 7.5 years in 45.8% of women. PAHG is also useful after previous incontinence surgery. The volume of PAHG injected did not influence the outcome.

Role of top flat magnetic stimulation for urinary incontinence as a debilitating condition of pelvic floor dysfunction: an observational evaluation of Latin American population.

Urinary incontinence (UI) is a common dysfunction of the pelvic floor, affecting 10-20% of all women, and up to 70% in the elderly general prevalence of 17% 20-year-old women and 38% in women over 60years. It is estimated that only 25% of patients seek treatment for this debilitating condition. The aim of this study was to evaluate the efficacy of a device based on top flat magnetic stimulation to treat pelvic floor disorders especially female urinary incontinence. A total of 33 volunteer patients were divided into 5 groups according to the type of complaint. Subjects received 8 treatment sessions, with a frequency of twice a week with two different settings. Pelvic Floor Bother Questionnaire (PFBQ), Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire (PISQ-12) and Urinary Incontinence Short Form (ICIQ-UI-SF) were compiled by all patients at the beginning and after 3months from the end of the last treatment (3MFU). The patient's scores from validated Questionnaires significantly decreased (p < 0.01) from baseline up to 3MFU inside most of the groups. The noninvasiveness and safety of device make this approach an interesting tool as alternative approach for pelvic floor dysfunctions .

Prevalence of urinary incontinence and other pelvic floor disorders in women with myotonic dystrophy type 1

Myotonic dystrophy type 1 (DM1) is a neuromuscular disease that can affect the pelvic floor muscles but few studies have investigated pelvic floor disorders, including urinary incontinence. The main purpose of this study was to document the prevalence, characteristics, and impacts of urinary incontinence and other pelvic floor disorders in women with DM1. Associations between pelvic floor disorders and phenotypes, considering age and parity, were explored. Eighty adult women aged 47,1±13,7 years old participated in a cross-sectional study using validated questionnaires, including the International Consultation Incontinence Questionnaire – Urinary Incontinence short form (ICIQ-UI-SF)), the Pelvic Floor Disorder Inventory (PFDI), and the Pelvic Floor Impact Questionnaire short form (PFIQ-SF). The mean score for the ICIQ-UI-SF was 4.3. The mean scores for the subscales of the PFDI were 36.8 for the urinary distress inventory, 74.1 for the colorectal-anal distress inventory, and 43.8 for the pelvic organ prolapse distress inventory. A total of 60% of women reported urinary incontinence and 56.3% anal incontinence. Pelvic prolapse symptoms (>1 symptom) were reported by 25% of women. Findings reveal high prevalence and significant related impacts of these disorders. This provides evidence regarding the importance of screening for these disorders in a clinical setting and the need to explore treatment approaches.