Urinary Loss Research Articles

An anatomical pathway for restoration of bladder neck closure by a midurethral sling, according to the integral theory.

A firm pubourethral ligament (PUL) is required to prevent the reflex posterior pelvic muscle forces forcibly opening out the posterior urethral wall on effort. A weak or loose PUL elongates on effort and this allows the posterior pelvic muscles to stretch open the posterior urethral wall causing urine loss, "stress urinary incontinence."Such forcible opening out of the urethra exponentially reduces the urethral resistance to flow inversely by the fourth power of the radius (i.e., 16 times). For example, if the radius doubles in size, the bladder pressure required for urine to flow out decreases by a factor of 16, from say, 160to 10 cm H2 O. A midurethral sling reinforces PUL to prevent the urethra opening out, thereby restoring both the distal urethral and bladder neck closure mechanisms.

Haemostatic profile of children with nephrotic syndrome attending University of Nigeria Teaching Hospital Ituku-Ozalla, Nigeria

BackgroundHaemostatic derangements are thought to be due to an imbalance between hepatic synthesis of pro-coagulants and urinary losses of anticoagulants.ObjectivesThis study evaluated the coagulation profile of Nigerian children with nephrotic syndrome and examined the relationship between coagulation variables, disease state and steroid responsiveness.MethodsA cross- sectional hospital based study on evaluation of coagulation profile of children with nephrotic syndrome compared with their age- and gender- matched controls.ResultsThe median fibrinogen level in subjects and controls was the same (2.9 g/L). Sixteen of 46 (35%) children with nephrotic syndrome had hyperfibrinogenaemia. The median fibrinogen level of children in remission was 2.3 g/L and differed significantly when compared with those of children in relapse (p = 0.001). The median APTT of children with nephrotic syndrome was 45.0 s and differed significantly compared with those of controls (42.0 s) (p value = 0.02). The median prothrombin time in children with and without nephrotic syndrome were 12.0 and 13.0 s respectively, (p = 0.004). About 90% of children with nephrotic syndrome had INR within reference range. Thrombocytosis was found in 15% of children with nephrotic syndrome. The median platelet count in children with new disease was 432 × 103cells/mm3 and differed significantly when compared with those of controls (p = 0.01).INR was significantly shorter in children with steroid resistant nephrotic syndrome (SRNS) (median 0.8 s; IQR 0.8 -0.9 s) compared with controls (median 1.0 s; IQR 1.0 -1.1 s) (p = 0.01). Steroid sensitivity was the strongest predictor of remission in children with nephrotic syndrome; steroid sensitive patients were 30 times more likely to be in remission than in relapse (OR 30.03; CI 2.01 – 448.04).ConclusionThis study shows that the haemostatic derangements in childhood nephrotic involve mostly fibrinogen, APTT, PT, INR and platelet counts. Antithrombin levels are largely unaffected. Variations in fibrinogen, APTT, PT and INR values may be due to the heterogeneous nature of the disease.

Long-term home parenteral nutrition and profile of amino acids in serum and their loss in urine.

Amino acids are an essential part of parenteral nutrition. This study aimed to determine the serum profile of amino acids and their loss in urine in patients with long-term home parenteral nutrition (HPN) during 12 h of infusion in comparison with similar parameters in the remaining 12 h as well as in healthy participants. We enrolled forty-five patients with long-term HPN for 6-75 (median, 33) months. The indication for HPN was short bowel syndrome secondary to radical resection of the small intestine following complications of Crohn's disease. HPN was administered via two-chamber all-in-one bags prepared in a hospital pharmacy overnight for 12 h each day. The average dose of amino acids, carbohydrates and fats administered was 1·5, 3·4 and 0·68 g/kg per d, respectively, at an infusion rate of 0·11, 0·28 and 0·06 g/kg per h, respectively. The levels of essential amino acids in the serum of the patients were not significantly different from those in healthy individuals; however, of the non-essential amino acids, cystine and glutamine levels were lower and glycine and ornithine levels were higher in the patients (P < 0·05). Excretion of amino acids in the urine during 12 h of infusion at an infusion rate of 0·11 g/kg per h was 301 mg, while it was 104 mg during the remaining 12 h (P < 0·0001). Our patients on long-term HPN had a normal serum profile of essential amino acids. The total urinary excretion of amino acids during 12 h of infusion accounted for only 0·34 % (0·23-0·46) of the administered dose.

BRAZILIAN OLYMPIC FEMALE ATHLETES’ MULTIDISCIPLINARY CARE: AN OBSERVATIONAL STUDY

ABSTRACT Introduction: Female participation in sports had reached a milestone in 1972 when a constitutional amendment was implemented to ensure equal opportunities for men and women. Since then, the percentage of participants in competitive sports has grown. In 1992, an association was made between three disorders related to female athletes called the “Female Athlete Triad”. After that, much has been studied about this and other particularities of female athletes. Objective: To identify the professionals who follow-up Brazilian female Olympic athletes and the association between a multidisciplinary approach and athletes’ knowledge about gynecological issues related to the practice of sport, i.e., female athlete triad, urinary incontinence, and weight control concerns. Methods: This observational study was conducted in Rio de Janeiro, Brazil, in 2016, during the Olympic Games. It included 120 female members of the Brazilian teams. A self-applied questionnaire, validated and adapted from the pre-participation gynecological evaluation of female athletes, was used to evaluate their multidisciplinary follow-ups, weight control concerns, and knowledge about the Female Athlete Triad and urinary incontinence. Results: The athletes practiced 28 different sports. For 66%, it was their first participation in Olympic Games; 56% were unaware of the female athlete triad, 77% indicated weight concerns, and 52% were on a diet. The use of diuretics or laxatives or vomiting was reported by 11%; 67.5% were aware that sports are a risk factor for urinary incontinence, and 40% had already experienced urine loss. Decreased sportive performance was mentioned by 31%. Several athletes presented multidisciplinary follow-ups psychological (83%), nutritional (96%), and gynecological (83%). Conclusion: Brazilian Olympic athletes sought multidisciplinary follow-ups during the Olympic cycle; however, participants’ knowledge of sports-related issues remains limited. An orientation program regarding the above conditions is needed for female athletes and the professionals working with them to improve health and performance. Evidence Level IV; Cross-sectional observational study.

Comparison of the Effectiveness of Pelvic Floor Muscle Exercises versus Pilates Exercises on Urinary Incontinence in Middle Aged Women”. Randomized Controlled Trial. RCT

Often impacting elderly women, the urinary incontinence is defined as the involuntary urine loss. Objective: The purpose of this study was to see the comparative effectiveness of pelvic floor muscle exercise with pilates training for treatment of urinary incontinence. Methods: The study's 36 patients who met the eligibility requirements were accepted. Prior to conducting any examinations, we obtained written informed consents from each participant. Patients with urinary incontinence were divided randomly into two groups. In ‘group A’ pelvic floor muscle exercises were applied while in ‘group B’ pilates training was applied. Allocation of patients in two groups was done by computerised generated list. Both groups received conventional therapy, which was the same throughout the study. The conventional therapy includes adductor strengthening of thigh and hot pack for 15 minutes. Group A received conventional therapy and pelvic floor muscle exercise while group B received conventional therapy and pilates training. Treatment frequency was 2 times a week. The duration of treatment was 6 weeks in both groups. Each patient's informed consent was obtained before the questionnaire was filled out. Scores were derived using the Questionnaire for Female Urinary Incontinence Diagnosis (QUID) and the International Consultation on Incontinence Questionnaire (ICIQ). Results: Patients in group A significantly outperformed those in group B. Conclusion: According to the study's findings, strengthening the pelvic floor muscles is superior than practicing pilates for treating stress urine incontinence. Pelvic floor exercises not only improved the urine leakage problem but also strengthened the muscle of abdomen and pelvis. So these exercises programs should be included in treatment plans along with medications in public health care for the welfare of patients.

Assessment of Levels of Complement Factors C3 and C4 in Lupus Nephritis Flare in Resource Limited Setup

Background: Renal biopsy, an invasive and costly procedure, is required to diagnose lupus nephritis. In some studies, complement levels C3 and C4 are being utilized as a diagnostic tool to distinguish whether active urine sediment, rising proteinuria and loss of renal function are attributable to systemic lupus erythematosus (SLE) activity or other non-immunological causes. Aim: To find out the frequency of altered levels of complement factors C3 and C4 in lupus nephritis with nephric or proteinuric flare. Methods: The present observational study was conducted in the Department of Nephrology, Services Hospital, Lahore. A total of fifty patients of lupus nephritis showing proteinuric, nephritic or mixed flare were enrolled. Demographics and clinical parameters were noted and C3 and C4 levels were measured. Both males and females were included in the study. This study was approved by the Institutional Review Board of the Services Institute of Medical Sciences. Results: Out of a total of 50 patients, 19 were males while 31 were females. The mean age of the patients was 29.40 ± 6.66 years. Low levels of complement factor C3 were discovered in 12(24%) of the patients, whereas low levels of complement factor C4 were detected in 18(36%) of the patients. Proteinuric flare was found in 17 patients, nephritic flare in 25 patients whereas both types of flare were found in a total of 8 patients. Conclusion: One-third of the patients with nephritic type flare of lupus nephritis had low levels of C3 or C4 in our study. Further studies with larger sample size are needed to assess the potential of complement levels C3 and C4 as tools to diagnose lupus nephritis flare. Keywords: Complement, C3, C4, Systemic lupus erythematosus, Lupus nephritis flare

Health Care Economic Burden of Treatment and Rehabilitation for Neurogenic Lower Urinary Tract Dysfunction: A Systematic Review.

The clinical, social, and economic impacts of neurogenic lower urinary tract dysfunction (NLUTD) on individuals and health care systems are thought to be immense, yet the true costs of care are unknown. The aims of this study are to illuminate the global costs related to the current state of care for NLUTD. A systematic review of the literature was performed using MEDLINE, the National Health Service Economic Evaluation Database, and the Cochrane Specialized Urology and Incontinence Registers. Studies reporting the health care costs of NLUTD were identified. All steps of the review were performed by 2 independent reviewers. Costs were converted to 2022 U.S. dollars and reported for different categories of services. A total of 13 studies were included in the final review (12 from high-income economy, and 1 from an upper-middle-income economy). Routine maintenance care varied notably across studies in terms of included services. Annual supportive costs ranged from $2,039.69 to $12,219.07 with 1 study estimating lifetime costs of $112,774 when complications were considered. There were limited data on the costs of care from the patient's perspective. However, catheters and absorbent aids were estimated to be among the costliest categories of expenditure during routine care. More invasive and reconstructive treatments were associated with significant costs, ranging between $18,057 and $55,873. NLUTD incurs a variety of health care expenditures ranging from incontinence supplies to hospitalizations for management of complications and leads to a significant burden for health care systems over the patient's lifetime. Approaches to NLUTD that focus on functional rehabilitation and restoration, rather than on management of complications, may prove to be a less costly and more effective alternative.

Impact of the suspension of neurogenic detrusor overactivity treatment with botulinum toxin due to the COVID-19 pandemic.

The COVID-19 pandemic has imposed an additional pressure on health systems worldwide. Patients with neurogenic detrusor overactivity (NDO) were especially vulnerable to inadequate care. This study aims to evaluate the impact of the suspension of NDO treatment with Botulinum Toxin (BONT-A) due to the COVID-19 pandemic. Cross-sectional study of patients with spinal cord injury and NDO, who underwent BONT-A treatment in 2018 or 2019 and, whose administration programed for 2020 or 2021 was suspended. The study protocol was divided into two parts. Phase 1 consisted of data collection from the clinical processes and in phase 2 a standardized telephone questionnaire was applied. Information was collected at 3 time points: (1) before the last BONT-A treatment, (2) after the last BONT-A treatment and (3) at the time of the telephone call. Statistical analysis used the McNemar and the Wilcoxon test with a p-value ⩽ 0.05 as level of significance. 21 patients with mean age of 42.0 years and disease duration of 16.9 years were included. On average patients were undergoing treatment with BONT-A for 7.6 years and mean inter-treatment frequency was 2.3 years. Mean time since the last BONT-A administration was 2.3 years and mean reported BONT-A effect duration was 11.9 months. A significant increase in the percentage of patients with involuntary urinary loss (p = 0.004) and urgency (p = 0.031) was found. A significant decrease in mean catheterization interval from 4.5 to 3.6 h (p = 0.002) and an increase in daily oxybutynin dosage from 8.5 to 12.1 mg (p = 0.002) was also found. The COVID-19 pandemic originated clinical worsening of patients undergoing regular BONT-A treatment for NDO. These patients presented a significant increase in involuntary urinary loss, urgency and medication dosage and a decrease in catheterization interval. Thus, interruption of intravesical BONT-A treatment severely affected these patients and needs to be avoided.

SGLT2 inhibitors: suggestions from the amphibian world

Sodium-glucose cotransporter 2 inhibitors are a class of antidiabetic drugs that inhibit glucose reabsorption in the proximal renal tubules. In many trials these drugs have shown unpredictable major cardio- and nephroprotective properties. Multiple hypotheses have been raised to elucidate the mechanisms underlying the last effects. Some authors suggest they may be due to the contemporary urinary loss of energy (as glucose) and water (by osmotic diuresis). This particular condition could induce metabolic changes resulting in more efficient energetics at cardiac and renal levels and in less oxidative stress. These changes might really be part of a series of evolutionarily conserved metabolic switches that allow organisms to survive in arid habitats with restricted nutrients and water availability, well studied in amphibians and collectively named “estivation”.

Vitamin D supplementation in children and young adults with persistent proteinuria secondary to glomerular disease.

Vitamin D deficiency is common in glomerular disease. Supplementation may be ineffective due to ongoing urinary losses of vitamin D binding protein. We sought to determine if daily cholecalciferol supplementation would increase vitamin D concentrations in children with glomerular disease and persistent proteinuria, without adverse effects. Eighteen participants at least 5years of age with primary glomerular disease and urine protein:creatinine ratio ≥ 0.5 were enrolled from four pediatric nephrology practices to receive cholecalciferol supplementation: 4,000IU or 2,000IU per day for serum 25 hydroxyvitamin vitamin D (25OHD) concentrations < 20ng/mL and 20ng/mL to < 30ng/mL, respectively. Measures of vitamin D and mineral metabolism were obtained at baseline and weeks 6 and 12. Multivariable generalized estimating equation (GEE) regression estimated mean percent changes in serum 25OHD concentration. Median baseline 25OHD was 12.8ng/mL (IQR 9.3, 18.9) and increased to 27.8ng/mL (20.5, 36.0) at week 6 (p < 0.001) without further significant increase at week 12. A total of 31% of participants had a level ≥ 30ng/mL at week 12. Supplementation was stopped in two participants at week 6 for mildly elevated calcium and phosphorus, respectively, with subsequent declines in 25OHD of > 20ng/mL. In the adjusted GEE model, 25OHD was 102% (95% CI: 64, 141) and 96% (95% CI: 51, 140) higher versus baseline at weeks 6 and 12, respectively (p < 0.001). Cholecalciferol supplementation in vitamin D deficient children with glomerular disease and persistent proteinuria safely increases 25OHD concentration. Ideal dosing to fully replete 25OHD concentrations in this population remains unknown. NCT01835639. A higher resolution version of the Graphical abstract is available as Supplementary information.

Articular Manifestations of X-Linked Hypophosphatemic Rickets in Saudi Children: A Retrospective Cohort Study

Introduction: This retrospective cohort study aimed to describe the articular manifestations in Saudi children with X-linked hypophosphatemic rickets (XLHR). Materials and Methods: The medical records of children with XLHR were retrospectively reviewed. The diagnosis of XLHR was confirmed biochemically by low serum phosphorus and elevated alkaline phosphatase, radiologically by the evidence of active rickets and genetically by phosphate-regulating gene with homology to endopeptidases (PHEX) gene mutations. Results: Twenty-two patients with XLHR (10.8 years + 4.9) were enrolled. All children were followed at King Faisal Specialist Hospital &amp; Research Center for a mean duration of 8.7 years (+3.7). Clinically, all patients had disproportionate short stature (-2.5 standard deviation +1.3) with varying degrees of skeletal deformities, including genu varum in 68%, genu valgum in 18%, coxa vara in 14%, bowing of tabia in 32%, and history of fractures in 32% of children. Hearing impairment was noted in two children. Biochemically, all patients showed increased urinary phosphate loss with hypophosphatemia 0.67 mmol/l (+0.15) and elevated serum alkaline phosphatase levels 522 IU/l (+133). Genetically, hemizygous PHEX mutation (C746F) was reported in seven patients. Radiologically, four children had osteoarthritis and three had enthesopathies. Four patients craniosynostosis. All children were on oral inorganic phosphate salts (50–70 mg/kg/day), combined with 1,25(OH)2D3 (alfacalcidol or calcitriol, 30–40 ng/kg/day). Conclusion: Patients with XLHR frequently present with varying degrees of joint deformities that are not completely resolved with either medical or surgical treatment. Long-term skeletal complications of XLHR that present in adults are less common in children and adolescents.

Managing incontinence in low-and middle income-countries: A qualitative case study from Pakistan.

Incontinence is a complex health and social issue, which involves the involuntary loss of urine or faeces or both. Individuals with disabilities are particularly vulnerable to incontinence. The management of incontinence has largely been overlooked in low and middle-income settings (LMICs). This study aimed to explore the incontinence management strategies employed by disabled people with severe incontinence and their caregivers in Sindh Province, Pakistan. Incontinence management was explored through in-depth interviews with people with incontinence (PWI) and their caregivers, photovoice, and a market survey and product attribute assessment. Data was analysed thematically through inductive coding and evaluated against existing disability and caregiver frameworks. Incontinence management affected all aspects of daily life for PWI and caregivers. Effective management of incontinence was prioritised because caregivers viewed it to be part of their familial duty and a requirement for the household to remain pure in the eyes of God. Coping strategies included strict adherence to routines, reducing food and drink intake, creative uses of locally available natural resources, and a heavy reliance on soap and water for maintaining hygiene. Products such as adult diapers were largely unavailable, costly and were not deemed suitable for regular use. There were no social or medical interventions in the region to support incontinence management. The main impacts of incontinence on the household were social isolation, stigma, role shifts within the family, the development of physical ailments among caregivers, and decreased income. The complex health, psychological, social, economic, and cultural impacts of incontinence are exacerbated in LMICs due a lack of recognition of the condition, the absence of social or medical interventions and limited access to basic WASH infrastructure, and assistive devices or products. Appropriate solutions need to be developed in partnership with PWI and caregivers and need to be contextualised, affordable and sustainable.

Effect of Pilates Ring Exercises on Pelvic Floor Muscles in Female with Stress Urinary Incontinence – Randomized Control Trial

Context: Urinary incontinence (UI) is defined by the International Continence Society as “Involuntary loss of urine which is unhygienic and social embarrassment causes negative self-perception.” UI is a problem which grows silently and causes physical as well as social limitations and deteriorates the quality of life (QOL) of women. Aims: The aim of this study is to find out the effect of Pilates exercises using the ring on the pelvic floor muscle (PFM) on PFM strength, severity of stress UI (SUI), and QOL in females with UI. Settings and Design: This study was conducted in the Outpatient Department, Dr. D. Y. Patil College of Physiotherapy, Pune, randomized control trial. Methods and Materials: Fifty-two females with SUI participated in the study. They were further divided into two groups Group A (experimental group [EG]) and Group B (control group [CG]). For the prepost assessment, vaginal pressure was measured by pressure manometer, core strength, severity of incontinence was assessed by using pad test (1 h) and frequency chart (7 days), QOL was measured using the International Consultation on Incontinence Questionnaire (ICIQ). Statistical Analysis Used: Between the groups, analyses were performed using independent t-tests and the Mann–Whitney test. The core strength and the PFM strength show highly significant change with P &lt; 0.05 in Group A compared to B, whereas the severity of incontinence on the frequency chart and QOL with ICIQ were not statically significant. Results: EG showed a highly significant difference in PFM and core P &lt; 0.05 in comparison to the control group. While moderate significance was seen in PFM strength and severity of the stress UI. Conclusions: The study concludes that Pilates with a ring along with the PFM exercises is a better alternative to only PFM exercise.

Abnormal urinary loss of vitamin C in diabetes: prevalence and clinical characteristics of a vitamin C renal leak

Diabetes is associated with low plasma vitamin C concentrations. We investigated the contribution of dysregulated vitamin C renal physiology, its prevalence, and associated clinical characteristics. An essential prerequisite was determination of normal vitamin C renal threshold, the plasma concentration at which vitamin C first appears in urine. Using data from 17 healthy participants who underwent vitamin C depletion-repletion studies with a vitamin C dose range of 15-1250mg daily, renal threshold was estimated using physiology-based pharmacokinetics modeling. Applying renal threshold 95% CIs, we estimated the minimal elimination threshold, the plasma concentration below which no vitamin C was expected in urine of healthy people. Renal leak was defined as abnormal presence of vitamin C in urine with plasma concentrations below the minimal elimination threshold. Criteria were tested in a cross-sectional cohort study of individuals with diabetes (82) and nondiabetic controls (80) using matched plasma and urine samples. Vitamin C renal thresholds in healthy men and women were [mean (SD)] 48.5 (5.2) µM and 58.3 (7.5) µM, respectively. Compared with nondiabetic controls, participants with diabetes had significantly higher prevalence of vitamin C renal leak (9% compared with 33%; OR: 5.07; 95% CI: 1.97, 14.83; P<0.001) and 30% lower mean plasma vitamin C concentrations (53.1 µM compared with 40.9 µM, P<0.001). Fasting plasma glucose, glycosylated hemoglobin A1c, BMI, micro/macrovascular complications, and protein/creatinine ratio were predictive of vitamin C renal leak. Increased prevalence of vitamin C renal leak in diabetes is associated with reduced plasma vitamin C concentrations. Glycemic control, microvascular complications, obesity, and proteinuria are predictive of renal leak.

Coexistence of SARS-CoV-2 and cerebrovascular diseases: does COVID-19 positivity trigger cerebrovascular pathologies?

The objectives of this study were to determine the prevalence of cerebrovascular diseases caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection, and to assess the pharmacological agents used in such cases as reported in the literature. Patient files were retrospectively scanned to determine the prevalence of neurological symptoms of the central nervous system (headache, dizziness, lack of smell and taste, numbness in arms and legs, change in consciousness, muscle weakness, loss of urine and stool control) and cerebrovascular diseases (ischemic cerebrovascular diseases, cerebral venous sinus thrombosis, intracerebral hemorrhage, subarachnoid/subdural hemorrhage) in 2019 novel coronavirus (2019-nCoV) disease (COVID-19) cases (n = 20,099). The diagnostic laboratory, radiology examinations and treatments applied to these cases were recorded. The data from studies presenting cerebrovascular diseases associated with SARS-Cov-2, which constituted 0.035% of all cases, were systematically evaluated from electronic databases. During the treatment of cerebrovascular diseases, it was discovered that high doses of enoxaparin sodium anti-Xa are combined with apixaban or acetylsalicylic acid or clopidogrel or piracetam, and mannitol, in addition to SARS-CoV-2 treatment modalities. While neurological symptoms of the central nervous system are uncommon in cases of SARS-CoV-2 infection, cerebrovascular diseases are far less common, according to the findings of this study. Acute cerebral ischemia was discovered to be the most common cerebrovascular disease associated with SARS-CoV-2. The mortality rate increases with the association between SARS-CoV-2 and cerebrovascular disease.

Diagnosis and Management of Central Diabetes Insipidus in Adults.

Central diabetes insipidus (CDI) is a clinical syndrome which results from loss or impaired function of vasopressinergic neurons in the hypothalamus/posterior pituitary, resulting in impaired synthesis and/or secretion of arginine vasopressin (AVP). AVP deficiency leads to the inability to concentrate urine and excessive renal water losses, resulting in a clinical syndrome of hypotonic polyuria with compensatory thirst. CDI is caused by diverse etiologies, although it typically develops due to neoplastic, traumatic, or autoimmune destruction of AVP-synthesizing/secreting neurons. This review focuses on the diagnosis and management of CDI, providing insights into the physiological disturbances underpinning the syndrome. Recent developments in diagnostic techniques, particularly the development of the copeptin assay, have improved accuracy and acceptability of the diagnostic approach to the hypotonic polyuria syndrome. We discuss the management of CDI with particular emphasis on management of fluid intake and pharmacological replacement of AVP. Specific clinical syndromes such as adipsic diabetes insipidus and diabetes insipidus in pregnancy as well as management of the perioperative patient with diabetes insipidus are also discussed.

Frequency of Urinary Stress Incontinence in Women after Vaginal Delivery

Introduction: Stress urinary incontinence is defined as involuntary loss of urine on physical exertion like coughing, sneezing, laughing or jumping. This condition in women is very distressing and it is usually kept disguised, so women remain untreated. This condition also causes feeling of inferiority and depression. There are different risk factors identified in causing urinary stress incontinence like constipation, traumatic and operative vaginal births, pelvic organ prolapse, abdominal mass, smoking, obesity, old age and menopause. The present study is design to know the actual magnitude of stress incontinence. There by strategies could be devised to reduce this morbidity. Objective: To determine the frequency of urinary stress incontinence in women after vaginal delivery Setting: This study was conducted at ISRA University Hospital, Hyderabad. Duration: Six months from Jan 2020 to June 2020. Design: Descriptive cross sectional. Subject and Methods: There were 141 women with history of urinary incontinence within 40 days of vaginal delivery were included in this study. Patient who fulfill the inclusion and exclusion criteria and came within forty days after vaginal delivery. The final outcome that is urinary stress incontinence was labeled as positive or negative on approved proforma. Results: The average age of the patients was 26.75±5.72 years. Frequency of urinary stress incontinence in women after vaginal delivery was observed in 14.18% (20/141). Conclusion: Results of this study suggest that the mechanical strain during labor may add to the risk associated with pregnancy itself. Prenatal counseling about routes of delivery should provide a balanced account of the advantages and disadvantages for mother and child. The information from this study provides important information for clinicians, patients, and policymakers regarding childbirth and incontinence. Keywords: Stress Urinary Incontinence, Vaginal Delivery, Operative Vaginal Births

Frequency of Different Types of Urinary Incontinence and Their impact on Quality of Life of Pakistani Women

The International Continence Society (ICS) defines Incontinence of urine as involuntary loss of urine. Objective: To determine the frequencies of different types of incontinence of urine and their impact on quality of life of Pakistani women. Method: Descriptive observational study was conducted at outpatient department of five centers. Three validated questionnaires were used for quality-of-life assessment, International Consultation Incontinence Questionnaire Short Form (ICIQ-SF), Medical Outcome Study 36 items Short Form (SF-36) and King's Health Questionnaire (KHQ). Result: The study included 436 women. The most frequent type of incontinence of urine was mixed (n=281, 64.45%) followed by stress incontinence (n=129, 29.59%) and urge incontinence (n=26, 5.96%). The women suffering from mixed type of incontinence of urine had maximum effect on quality of life both general and specific. Conclusions: All types of incontinence of urine had an effect on quality of life but the mixed type had more impact.

Assessment of Stress Incontinence in Indian Female CrossFit Trainers Aged 20-40 Years: A Cross-Sectional Study

Background: Stress incontinence is involuntary and uncontrollable loss of urine which is caused by activities that elevate intra-abdominal pressure. Cross fit training involves exercises which are performed above the normal level of intensity of other form of exercises. Although these set of exercises strengthen abdominal muscles, they eventually cause weakening of pelvic floor muscles making them susceptible to develop stress incontinence. Objective: To study and assess stress incontinence in Indian Female cross Fit trainers aged 20-40 years. Method: n = 100 subjects were included in the study who then performed pad test. Based on the results of pad test, they were classified as continent or incontinent. Further they filled Questionnaire for urinary incontinence (QUID) which confirmed whether they were suffering from stress incontinence or urgency incontinence Results: Female cross fit trainers in the age group of 20-40 years with an average of 23.67 (±5.92 years), were segregated into 4 age groups, that is 20- 25 years, 26-30 years, 31-35 years and 36-40 years. Majority of females in age group of 36-40 were positive for pad test. Out of the total females positive, in nulligravid females, only 1 female was positive for pad test, in females who were primigravid 7 females were positive for pad test and in multigravida females that is females with 2 children15 were positive for pad test. Conclusion: The study concludes that there is a positive correlation between age of women and parity on incontinence. Keywords: Stress urinary incontinence (SUI), Parity, Pelvic floor muscles (PFM).

THE MECHANISM OF URINARY CONTROL AND OPERATIONS OF SYNTHETIC SLING

Background: Over the past two decades, synthetic loop surgeries have gained widespread popularity due to their ease of implementation, relatively high efficiency and low cost in the treatment of women with stress urinary incontinence (SUI). To date, several dozen variants of minimally invasive surgical procedures are known, but none of the known methods provides a 100% reliable result. At the same time, the effectiveness of the performed operation to eliminate involuntary loss of urine is inexorably reduced in the follow-up.Aims of the study. On the basis of a neuroregulatory theory published in 2019 and according to a neurophysiological model, provide an explanation for both the mechanism of urinary retention and the role of the tape implanted under the urethra in its recovery.Material and methods. Analysis of a large number of foreign and domestic literary sources, the results of clinical observations of surgery using the original author's version of the trocar synthetic sling (TSS) for 19 years, the data of the original method of uroflowmetric monitoring.Results. Taking into account the created and published theoretical basis, an explanation is presented for the effect of increasing the tone of the pelvic floor muscles in women with urinary incontinence after surgical correction using modern synthetic materials.Conclusions. The restoration of the mechanism of urinary retention in women after the operation of a synthetic sling occurs under the condition of activation of the 4th mictional reflex. In the event of a violation of the components of this reflex, the effectiveness of the sling procedure decreases and a recurrent form of the disease occurs, regardless of the type and volume of the operation used. The presence of a theoretical basis that explains both the mechanism of urinary retention itself and the pathogenesis of the development of the disease allows us to offer options for conservative therapy to prepare for the sling procedure and thereby increase the follow-up efficiency of any loop surgery.