Urinary Tract Symptoms In Women Research Articles

Prevalence of Lower Urinary Tract Symptoms in Women Planning to Undergo Hysterectomy for Uterine Leiomyoma and Abnormal Uterine Bleeding.

Introduction: Leiomyomas are associated with lower urinary tract symptoms (LUTS), but more specific characterization of their impact on LUTS is needed. Methods: This is a retrospective cohort study of 202 participants (101 per group) who underwent hysterectomy for leiomyomas versus abnormal uterine bleeding nonclassified (AUB-N) from July 2015 to May 2019. Baseline demographics, leiomyoma characteristics, and presence of baseline LUTS were collected. The main objective was to compare the prevalence of LUTS between these two groups. Secondary objectives were to analyze the association between leiomyoma characteristics and the prevalence of LUTS. Results: There was no difference in baseline prevalence of LUTS between the hysterectomy for leiomyoma versus AUB-N groups (42.6% vs. 45.5%, p = 0.67). When examining the entire study cohort of participants, irrespective of hysterectomy indication, leiomyoma size >6 cm was associated with an increased prevalence of LUTS when compared with leiomyoma <6 cm (64.9% vs. 40.4%, p = 0.02), and specifically difficulty passing urine (p = 0.02), nocturia (p = 0.04), and urinary frequency (p = 0.04). When controlling for age, body mass index, parity, chronic pelvic pain, and diabetes, leiomyomas >6 cm remained significantly associated with the presence of LUTS (odds ratio 3.1, 95% confidence interval = 1.2-8.3) when compared with leiomyoma <6 cm. Presence of >1 leiomyoma was associated with urinary frequency (67.9% vs. 32.1%, p = 0.02) when compared with ≤1 leiomyoma. Anterior location and uterine volume were not associated with a difference in LUTS. Conclusion: LUTS are prevalent in those planning hysterectomy for leiomyoma and AUB-N. Leiomyomas >6 cm are associated with the presence of LUTS. Future studies should evaluate change in LUTS following hysterectomy for leiomyomas.

Single-dose Tadalafil Reduces Opening Urethral Pressure: A Randomized, Double-blind, Placebo-controlled, Crossover Trial in Healthy Women

Introduction and HypothesisPhosphodiesterase enzymes are widely distributed in female urogenital tissues. Yet, the understanding of their physiological roles and the impact of phosphodiesterase inhibitors on lower urinary tract symptoms in women remains limited. Current hypotheses are conflicting: one suggests that vasodilation might expand the periurethral vascular plexus, leading to increased urethral pressure, whereas the other proposes a relaxation of urethral musculature, resulting in decreased pressure. To further clarify this, we investigated the effect of tadalafil on the opening urethral pressure and voiding function in healthy women.MethodsWe conducted a randomized, double-blind, placebo-controlled crossover trial involving 24 healthy women. Participants were randomly assigned to receive a single dose of tadalafil (40 mg) or placebo during their initial visit and then switched to the alternative treatment during their second visit. Opening urethral pressure was measured with urethral pressure reflectometry during both resting and squeezing conditions of the pelvic floor. Subsequently, voiding parameters were recorded.ResultsCompared with placebo, a single dose of tadalafil significantly reduced opening urethral pressure during both resting (-6.8 cmH20; 95% confidence interval [CI], -11.8 to -1.9; p = 0.009) and squeezing conditions (-8.8 cmH20; 95% CI, -14.6 to -3.1; p = 0.005). Voiding parameters did not show significant differences (average flow rate: -0.8 ml/s [95% CI, -2.0 to 0.4; p = 0.2]; maximum flow rate: -1.7 ml/s [95% CI, -4.8 to 1.5; p = 0.3]).ConclusionsA single dose of 40 mg tadalafil moderately reduced urethral pressure in healthy women, without affecting voiding parameters. The clinical implications of this are yet to be determined.

8571 Prevalence of Baseline Lower Urinary Tract Symptoms in Women Planning to Undergo Hysterectomy for Uterine Fibroids

Study Objective Compare the prevalence of baseline lower urinary tract symptoms (LUTS) in women planning to undergo hysterectomy for fibroids versus abnormal uterine bleeding (AUB) and examine their association with fibroid characteristics Design This is a retrospective cohort study of 202 women planning to undergo hysterectomy for fibroids vs. AUB. The aim was to compare LUTS in those with vs without fibroids. Baseline demographics, fibroid characteristics, and urinary symptoms were collected. Urinary symptoms included stress and urge incontinence, dysuria, frequent bladder infections, hematuria, nocturia, incomplete emptying, urgency, and frequency. Fibroid characteristics included dominant fibroid size, location, and total uterine volume. A priori power analysis determined 97 participants were needed per group (194 total) to assess for a 20% difference in LUTS, with alpha = 0.05 and power = 0.8. 202 participants were included to account for missing data upon chart review. Setting N/A. Patients or Participants Participants were identified from a surgical database. They were eligible for inclusion if they were planning to undergo hysterectomy for fibroids or AUB from 2014-2019. Interventions N/A. Measurements and Main Results When assessing baseline LUTS in women planning to undergo hysterectomy for fibroids vs. AUB, there were no differences in individual symptoms (all p>0.05) or in prevalence of ‘any urinary symptom’ as a single variable (42.6 vs 45.5%, p=0.67). Dominant fibroid size >6cm was correlated with greater prevalence of ‘any urinary symptom’ (64.9% vs 40.4%, p=0.02), as well as difficulty passing urine (p=0.02), nocturia (p=0.04), and urinary frequency (p=0.04). When controlling for age, BMI, parity, chronic pelvic pain, and diabetes, fibroids >6cm remained significantly associated with the presence of lower urinary tract symptoms (OR 3.1, 95% CI 1.2-8.3). Conclusion Lower urinary tract symptoms are prevalent in women planning to undergo hysterectomy for fibroids, particularly in those with fibroids >6 cm. Future studies should evaluate how urinary symptoms change following hysterectomy. Compare the prevalence of baseline lower urinary tract symptoms (LUTS) in women planning to undergo hysterectomy for fibroids versus abnormal uterine bleeding (AUB) and examine their association with fibroid characteristics This is a retrospective cohort study of 202 women planning to undergo hysterectomy for fibroids vs. AUB. The aim was to compare LUTS in those with vs without fibroids. Baseline demographics, fibroid characteristics, and urinary symptoms were collected. Urinary symptoms included stress and urge incontinence, dysuria, frequent bladder infections, hematuria, nocturia, incomplete emptying, urgency, and frequency. Fibroid characteristics included dominant fibroid size, location, and total uterine volume. A priori power analysis determined 97 participants were needed per group (194 total) to assess for a 20% difference in LUTS, with alpha = 0.05 and power = 0.8. 202 participants were included to account for missing data upon chart review. N/A. Participants were identified from a surgical database. They were eligible for inclusion if they were planning to undergo hysterectomy for fibroids or AUB from 2014-2019. N/A. When assessing baseline LUTS in women planning to undergo hysterectomy for fibroids vs. AUB, there were no differences in individual symptoms (all p>0.05) or in prevalence of ‘any urinary symptom’ as a single variable (42.6 vs 45.5%, p=0.67). Dominant fibroid size >6cm was correlated with greater prevalence of ‘any urinary symptom’ (64.9% vs 40.4%, p=0.02), as well as difficulty passing urine (p=0.02), nocturia (p=0.04), and urinary frequency (p=0.04). When controlling for age, BMI, parity, chronic pelvic pain, and diabetes, fibroids >6cm remained significantly associated with the presence of lower urinary tract symptoms (OR 3.1, 95% CI 1.2-8.3). Lower urinary tract symptoms are prevalent in women planning to undergo hysterectomy for fibroids, particularly in those with fibroids >6 cm. Future studies should evaluate how urinary symptoms change following hysterectomy.

Lower urinary tract symptoms in an elderly women caused by degeneration of the pubic symphysis

BackgroundLower urinary tract symptoms are very common in elderly women, and transvaginal delivery and multiple deliveries have been confirmed to be risk factors. Transvaginal delivery and multiple deliveries may lead to an increase in pubic symphysis degeneration.Case presentationA 79-year-old woman consulted a urologist because of worsening lower urinary tract symptoms such as frequent urination and urodynia. Color ultrasound and cystoscopy suggested the possibility of a bladder mass. A lump on the anterior wall of the bladder was observed although the surface mucosa was normal. Physical examination showed obvious tenderness in the posterior area of the pubic symphysis. Further urological computed tomography (CT) and pelvic magnetic resonance imaging (MRI) showed a nodular bony protuberance in the posterior part of the pubic symphysis, which was more obvious than before, with compression changes near the anterior wall of bladder. Open pelvic surgery showed that nodular bone tissue originating from the pubic symphysis significantly oppressed the anterior wall of the bladder behind the pubic symphysis. After resection of the nodule, the lower urinary tract symptoms were relieved significantly.ConclusionsPubic symphysis degeneration caused by transvaginal delivery may be an important cause of lower urinary tract symptoms in women. Pelvic CT or MRI is necessary to diagnosis this condition.

The Epidemiology and Population-Based Studies of Women with Lower Urinary Tract Symptoms: A Systematic Review.

In this systematic review, we focused on epidemiology and population-based studies to identify recent realworld data of women with lower urinary tract symptoms. The PubMed, Scopus, and Cochrane databases were used for the literature search using the following keywords: epidemiology, population-based studies, women, female, lower urinary tract symptoms, and urinary incontinence. A total of 20 articles in the English language were found to be eligible for this review. The prevalence of LUTS in women was 11.8%-88.5%. The prevalence of storage symptoms was 23.6%-79%, voiding symptoms was 1.8%-51%, and post-micturition symptoms was 0.3%-46%. The prevalence of voiding and storage symptoms was 8.3%-26.6% and the prevalence of combined voiding, storage, and post-micturition symptoms was 6.6%-19.2%. Any incontinence was observed in 5.8%-45.8% of women. The majority of patients suffered from stress urinary incontinence with 1.9%-31.8%. The prevalence of urgency urinary incontinence and mixed-type urinary incontinence was 0.7%-24.4% and 2.1%-12%, respectively. Increased age, marital and work status, comorbidities, alcohol consumption, higher parity, vaginal delivery, instrumental delivery, prolonged labor, laceration, and postmenopausal status were found to be risk factors for lower urinary tract symptoms. The prevalence of lower urinary tract symptoms in women is increasing, especially with age. Since the worldwide prevalence of lower urinary tract symptoms remains unknown, multi-continental studies, especially in the developing world, with less heterogeneity and more standardized definitions, are needed to better evaluate real-world data in women with lower urinary tract symptoms.

Challenges of Managing Lower Urinary Tract Symptoms in Women with Tamoxifen Use.

Objective:Tamoxifen complicates management of conditions such as urinary tract infections (UTIs), urinary incontinence (UI), and/or pelvic organ prolapse (POP) that traditionally benefit from hormonal intake; thus, we reviewed our experience in managing these hormonally deprived women.Materials and Methods:After IRB approval, electronic medical records from women with current use or history of tamoxifen use and referred to a tertiary care center with female pelvic medicine and reconstructive surgery expertise for UTI, UI, and/or POP were reviewed.Results:From 2015 to 2020, 32 women treated with tamoxifen 10–40 mg for a median of 4 years were referred for UTIs (9), UI (10), symptomatic POP (8), or for a combination of these (5). Participants with UTI treated with antibiotics, prophylactic supplements, and/or electrofulguration had satisfactory response at median follow-up of 1 year (interquartile range [IQR]: 0.5–1). Ten of 15 women with UI chose intervention, with no self-reported UI recurrence at median follow-up of 2.5 years (IQR: 1–3). All but one participant with POP underwent vaginal or open/robotic mesh repairs, with satisfactory outcomes at median follow-up of 3 years (IQR: 2–7).Conclusions:The management of UTIs, UI, and POP in women on tamoxifen or unable to benefit from hormonal intake is challenging, but traditional interventions can be considered with satisfactory results.

ASSESSMENT OF EFFICIENCY OF COMBINED PHARMACOTHERAPY FOR IMPERATIVE AND MIXED URINARY DISORDERS IN WOMEN WITH THE INTERVAL SCALE

Introduction.The search for effective drug combinations for treating continental disorders in women is still relevant. The interval scale for assessing lower urinary tract symptoms in women is a simple and convenient tool for monitoring pharmacotherapy. Objective: to evaluate the effectiveness of treatment of imperative and mixed urination disorders in women with alpha1-blockers in combination with nootropic drugs using an interval symptom rating scale.Materials and methods.Under observation there were 31 patients aged 40 to 73 years who applied to the Center “Urination Pathology” with mixed and imperative disorders of the continent and urinary incontinence. Conservative therapy was carried out with the appointment of alpha1-adrenoblockers, nootropic and metabolic drugs for an average of 5.8 months. The therapeutic effect is recorded using the interval symptom score scale.Results.After discontinuation of drugs, the overall score on the symptom rating scale decreased by 40.2%, imperative symptoms – by 29.5-50%, and quality of life increased by 19%. In the group of women aged 40-49, with comparable dynamics of symptoms with patients older than 50 years, therapy lasted less. The difference averaged 4.1 months and was associated with a higher frequency in the older age group of vascular, metabolic and neurological disorders that slow down the regulatory processes of urination recovery.Conclusion.Alpha1-blockers and nootropics are pathogenetically substantiated for the treatment of imperative disorders of urination and urinary incontinence. Evaluation using the interval scale reliably demonstrates their high clinical effectiveness, persistence of the therapeutic effect and the feasibility of application at the stage of selection for surgical treatment.

Assessment of Female Sexual Dysfunction and Erectile Dysfunction and Its Association with Lower Urinary Tract Symptoms in Women and Men Over 18 Years Old: Results From the COBaLT Study

BackgroundFemale sexual dysfunction and erectile dysfunction (FSD/ED) have been linked with lower urinary tract symptoms (LUTS), from both epidemiological data and basic research studies, but few studies have been conducted in Latin America addressing these issues and most of them do not include the young population. AimTo determine the prevalence of FSD/ED and its association with LUTS in Colombia. MethodsSub-analysis of a cross-sectional, population-based study conducted in subjects ≥18 years old to evaluate LUTS/OAB. The estimated sample size was 1,054. ED was defined as ≤21 points in the SHIM and FSD as ≤19 in the FSFI-6. For LUTS/OAB, we used the 2002 ICS and 2010 IUGA/ICS definitions and validated questionnaires. Descriptive and inferential statistics were employed. OutcomesPrevalence of FSD/ED and association of FSD/ED and LUTS. ResultsWe included 1,060 participants; the median age was 40 (IQR 27–54) years. Fifty-seven (11.4%) men and 182 (32.7%) women were sexually inactive. The prevalence of FSD/ED in sexually active participants was 47% (men 52.9%, women 38.9%). The most common FSD/ED symptoms were diminished/absent lubrication in women (42%) and diminished erection maintenance after penetration in men (13%). Individuals with FSD/ED had higher rates of various LUTS. The multivariable logistic regression model found that the city of residence (OR = 0.4, 95% CI 0.2–0.9), diabetes mellitus (DM) (OR = 8.4, 95% CI 1.4–48.7), menopause (OR=3.5, 95% CI 1.9–6.2), urge urinary incontinence (UUI) (OR=1.9, 95% CI 1.1–3.3) and nocturia ≥2 (OR = 2.2, 95% CI 1.2–4.2) were associated with FSD. In men, age 40–59 (OR = 2.3, 95% CI 1.4–3.7) and ≥60 (OR = 5.5, 95% CI 2.4–12.5), the city of residence (OR = 0.2, 95% CI 0.1–0.3), less than a high-school diploma vs higher education (OR = 2.0, 95% CI 1.2–3.2), depression (OR = 4.6, 95% CI 1.8–11.5), UUI (OR = 3.2, 95% CI 1.1–10.2) and feeling of incomplete bladder emptying (OR = 2.1, 95% CI 1.3–3.5) were associated with ED. Clinical ImplicationsThis study underlines the importance of assessing LUTS in women and men of all affected age groups who present with symptoms of FSD/ED and vice versa, which could help achieve a better approach for these patients. Strengths & LimitationsThis is the first study in Colombia and one of the few in Latin America that addresses both FSD/ED and LUTS in men and women aged 18 years and older. Limitations include being a sub-analysis of a study aiming to determine the prevalence of LUTS/OAB and not FSD/ED. ConclusionsRegardless of age, LUTS were observed more frequently in patients with FSD/ED. Various LUTS were associated with FSD/ED.Bravo-Balado A, Trujillo CG, Caicedo JI, et al. Assessment of Female Sexual Dysfunction and Erectile Dysfunction and Its Association with Lower Urinary Tract Symptoms in Women and Men Over 18 Years Old: Results From the COBaLT Study. J Sex Med 2021;18:1065–1074.

Association of decreased grip strength with lower urinary tract symptoms in women: a cross\u2010sectional study from Korea

BackgroundLower urinary tract symptoms (LUTS) including frequency, nocturia, urgency, and incontinence, are common in women and cause significant discomfort in daily life. However, diagnosis and treatment of LUTS are often delayed because many patients with such symptoms do not complain to the physician of discomfort and do not seek medical attention. LUTS are known to be associated with muscle weakness. We investigated the association between grip strength and LUTS in women of different ages.Methods This study included 4225 women (mean age 48.6 years) who underwent self-referred health screening between April 2015 and December 2019. LUTS were evaluated using a self-reported questionnaire, and the overactive bladder symptom score was used to screen for an overactive bladder. Low muscle strength was defined as a hand grip strength of < 18 kg (decreased grip strength).ResultsWe observed decreased grip strength in 13.7% (n = 580) of the participants. Nocturia, urgency, incontinence, and overactive bladder were more common in women with decreased grip strength than in women with normal grip strength. After adjusting for age, comorbidities (hypertension, diabetes, hyperlipidemia), smoking status, alcohol consumption, regular exercise, and stress, nocturia (odds ratio [OR] 1.19, 95% confidence interval [CI] 1.01–1.52), urinary incontinence (OR 1.32, 95% CI 1.01–1.72), and an overactive bladder (OR 1.75, 95% CI 1.35–2.27) were significantly associated with decreased grip strength.ConclusionsThe findings suggest that LUTS, especially nocturia, incontinence, and an overactive bladder are associated with decreased grip strength in women. Therefore, physicians should be aware that patients may not seek help, even if they are uncomfortable, and it is important to obtain a detailed medical history and perform additional tests, even in the absence of complaints, in patients with low grip strength, who are at high risk of LUTS.

Prevalence of childhood trauma and its association with lower urinary tract symptoms in women and men in the LURN study.

To describe the association between childhood traumas (death of a family member, severe illness, sexual trauma, parental separation) reported by women and men and lower urinary tract symptoms (LUTS). In this secondary analysis of the Lower Urinary Tract Research Network Observational Cohort Study, participants completed the LUTS tool, childhood trauma events scale (CTES), PROMIS depression and anxiety and perceived stress scale. LUTS tool responses were combined to quantify urinary urgency, frequency, incontinence, and overall LUTS severity. Multivariable linear regression tested associations between trauma and LUTS; mental health scores were tested for potential mediation. In this cohort (n = 1011; 520 women, 491 men), more women reported experiencing at least one trauma (75% vs. 64%, p < .001), greater than three traumas (26% vs. 15%, p < .001), and childhood sexual trauma (23% vs. 7%, p < .001), and reported higher impact from traumatic events compared with men (median [interquartile rnage] CTES score = 10 [5-15] vs. 6 [4-12], p < .001). The number of childhood traumatic events was not associated with severity of overall LUTS (p = .79), urinary frequency (p = .75), urgency (p = .61), or incontinence (p = .21). Childhood sexual trauma was significantly associated with higher incontinence severity (adjusted mean difference 4.5 points, 95% confidence interval= 1.11-7.88, p = .009). Mental health was a mediator between trauma and LUTS among those with at least one childhood trauma. Although total childhood trauma is not associated with LUTS, childhood sexual trauma is associated with urinary incontinence severity. For patients with childhood trauma, half of the effect of CTE Impact score on overall LUTS severity is mediated through the association between trauma and the patient's mental health.

Videourodynamic precision diagnosis and treatment of lower urinary tract symptoms in women

Lower urinary tract symptoms (LUTSs) in women are common in urological practice but are usually uninformative for diagnosing the underlying lower urinary tract dysfunction. To obtain a precise diagnosis and devise a precise treatment strategy, a videourodynamic study (VUDS) is an essential tool for investigating the bladder and bladder outlet dysfunction, especially when LUTS cannot be relieved after initial medical treatment. An accurate VUDS diagnosis can guide effective treatment and prevent unnecessary or incorrect surgical intervention. This article reviews updated applications of VUDS in the diagnosis and treatment of LUTS in women.

“True gold fears no fire” – High-quality videourodynamic studies make possible precision diagnosis of lower urinary tract symptoms in women

“True gold fears no fire” – High-quality videourodynamic studies make possible precision diagnosis of lower urinary tract symptoms in women

Effect of the symptom-based alpha-blocker treatment on lower urinary tract symptoms in women: systematic review and meta-analysis.

Aims:The aim of this study was to evaluate the effects of alpha blockers in women with lower urinary tract symptoms.Methods:We conducted systematic review and meta-analysis on published a priori protocols. We searched multiple data sources for published and unpublished randomized controlled trials in any language. Primary outcomes included urologic symptom scores, quality of life, and overall adverse events. We performed meta-analysis using RevMan 5.3 and rated the certainty of evidence using Grading of Recommendations, Assessment, Development, and Evaluation.Results:Alpha blockers likely reduced urological symptom score (mean difference: −1.50, 95% confidence interval: −2.91 to −0.09; moderate certainty of evidence). Alpha blockers may improve quality of life (standardized mean difference: −0.35, 95% confidence interval: −0.85 to 0.15; low certainty of evidence) and have little to no difference in overall adverse events (risk ratio: 1.09, 95% confidence interval: 0.55 to 2.15; low certainty of evidence). Based on five studies comparing combination therapy with alpha blockers and anticholinergics to anticholinergic monotherapy, combination therapy likely results in little to no difference in urological symptom score (mean difference: −0.35, 95% confidence interval: −1.98 to 1.27; moderate certainty of evidence) and quality of life (mean difference: −0.11, 95% confidence interval: −0.48 to 0.27; moderate certainty of evidence). We are very uncertain about the effect of combination therapy on overall adverse events (risk ratio: 1.07, 95% confidence interval: 0.40 to 2.84; very low certainty of evidence).Conclusion:Alpha blocker monotherapy for the women with lower urinary tract symptoms regardless of the underlying cause likely has satisfactory efficacy compared with placebo. However, combination therapy with anticholinergics likely has no additional effect on urologic symptom score and quality of life compared with anticholinergic monotherapy.

Impact of smoking habit on overactive bladder symptoms and incontinence in women.

ObjectiveTo examine the correlation between smoking habit and lower urinary tract symptoms in women.MethodsWe first screened 10 000 female patients to examine their smoking habit. A total of 7004 samples were successfully collected for further analysis through a urinary continence survey. The ratio of current smoking to non‐smoking participants was set as 1:3 to allow thorough assessment of the impact of cigarette smoking on lower urinary tract symptoms.ResultsA total of 4756 complete responses were obtained for the Overactive Bladder Symptom Score and International Consultation on Incontinence Questionnaire‐Short Form questionnaire. The current smokers (2.54 ± 2.91, 2.48 ± 4.01) and ex‐smokers (2.27 ± 2.50, 2.25 ± 3.50) showed significantly higher Overactive Bladder Symptom Score and International Consultation on Incontinence Questionnaire‐Short Form scores than the non‐smokers (1.70 ± 2.05, 1.49 ± 2.73) (P < 0.0001, P < 0.0001 and P < 0.0001, P < 0.0001, respectively). The prevalence of urgency was affected by the smoking status. Younger participants (aged 20–39 years) showed a stronger influence of their smoking habit than older participants (aged ≥40 years). Urgency urinary incontinence was also affected by the smoking status.ConclusionsThe prevalence of urgency and urgency urinary incontinence is correlated with age and smoking habit, and both current and ex‐smokers show an increased prevalence of urgency and urgency urinary incontinence compared with non‐smokers, especially younger women.

Unsupervised behavioral and pelvic floor muscle training programs for storage lower urinary tract symptoms in women: a systematic review

This study synthesized the effects of unsupervised behavioral and pelvic floor muscle training (B-PFMT) programs on outcomes relevant to women's storage lower urinary tract symptoms (LUTS) and pelvic floor muscle strength (PFMS). PubMed, CINAHL, Web of Science, and PsycINFO were searched since their inception to August 6, 2019. Randomized controlled trials (RCTs) and quasi-experimental articles that enrolled community women aged 18years and older and reported storage LUTS outcomes including symptoms, severity, impact, self-reported symptom improvement, and PFMS were screened and extracted. Risk of bias was evaluated, and a narrative synthesis approach was used to synthesize evidence. Ten RCTs and three pretest-posttest articles were retrieved. Half of the RCTs had some concerns of bias; the remaining RCTs had high risk of bias. Three pretest-posttest articles had at least some risk of bias. Ten articles aimed to treat urinary incontinence (UI) primarily in middle-aged women, two aimed to prevent UI, and one aimed to improve PFMS in young continent women. Two months post-intervention, UI treatment effectiveness was observed, and cumulative effectiveness was evident in: (1) reduction in the number of incontinent episodes, (2) reduction in the International Consultation on Incontinence Questionnaire-Urinary Incontinence-Short Form and International Consultation on Incontinence Questionnaire-Lower Urinary Tract Symptoms Quality of Life scores, (3) increased patients' global impression of improvement, and (4) improvement of PFMS. Unsupervised B-PFMT programs improve outcomes relevant to UI and PFMS in midlife community women who have UI. Their effects on UI prevention and other storage LUTS remain unclear.

Converging on Bladder Health through Design Thinking: From an Ecology of Influence to a Focused Set of Research Questions.

Lower urinary tract symptoms affect a substantial number of women in the United States (U.S.) and globally. In 2015, the Prevention of Lower Urinary tract Symptoms in women (PLUS) Research Consortium was funded to establish the scientific basis for prevention efforts by (1) understanding healthy bladder function and (2) identifying risk and protective factors for bladder health in women across the lifecourse. This transdisciplinary consortium generated a list of over 600 candidate risk and protective factors for bladder health in women and girls and refined and prioritized these into 29 focused research questions to inform a national longitudinal observational study in the U.S. This paper describes that process using design thinking, a human-centered set of principles and strategies by which innovations are developed, as a framework. Design thinking is an iterative process consisting of five stages: Empathizing with end-users of innovations, Defining core principles girding the work, Ideation of all possible solutions, and rapid-cycle Prototyping and Testing of solutions. Lessons learned are offered to inform future prevention science research endeavors that might benefit from such an approach.

Childhood nocturnal enuresis\u2014a marker for pelvic floor disorders and urinary tract symptoms in women?

Introduction and hypothesisA systematic survey on the association between childhood nocturnal enuresis (CNE) and adult pelvic floor disorders (PFDs) has not been presented previously. The aim was to describe the prevalence of PFDs and lower urinary tract symptoms in nulliparous women, with or without a history of CNE, at the age of ≥ 5 years.MethodsThis national survey of urinary (UI) and fecal incontinence (FI) and symptoms of pelvic organ prolapse (sPOP) was a random sample of 20,000 nulliparous women aged 25–64 years conducted in 2014. Women ≥ 5 years of age having CNE were compared with those without the condition. Fisher’s exact test and logistic regression adjusted for BMI and age were used to analyze differences between groups.ResultsThe response rate was 52% and 10.2% of adult women reporting CNE. One or more PFDs occurred in 38.3% of women with CNE compared to 23.8% in those without CNE (p < 0.0001). Mixed UI had the strongest association with CNE, odds ratio (OR) 2.63 (95% CI 2.03–3.40). The rate of FI was 11.2% in the non-CNE group and 16.8% in those with CNE (p < 0.0001) and sPOP 2.6% in the non-CNE and 4.8% in the CNE group (p = 0.0004), respectively. The prevalence of lower urinary tract symptoms was consistently higher in women with a history of CNE: overactive bladder 32.6% versus 18.4% (OR 2.34 95% CI 2.03–3.40), daytime micturition ≥ 8/day 29.6% versus 24.0% (p < 0.0001), and nocturia ≥ 2/night 12.4% versus 7.8% (p < 0.0001) in the CNE group.ConclusionPFDs and lower urinary tract symptoms in nulliparous women were approximately doubled in women with a history of CNE and could therefore act as a strong confounding factor.

The Relationship between Vitamin D Level and Lower Urinary Tract Symptoms in Women.

Objectives:In the literature, the effects of vitamin D on lower urinary tract symptoms (LUTS) have been investigated. Conflicting results have been reported in these studies conducted. LUTS is more common in women. In this study, we aimed to evaluate the relationship between vitamin D and LUTS in female patients using the uroflowmetric method.Methods:This retrospective cohort study included 186 female patients who were admitted with LUTS. Demographic characteristics, medical history, calcium (Ca) and vitamin D, including laboratory studies and uroflowmetry results, as maximum urine flow rate (Qmax), average urine flow rate (Qav) and voided volume (V) were recorded. Patients were divided into two groups according to age (18-50 and ≥51) and vitamin D levels (<20 and ≥20). Laboratory parameters and uroflowmetry results were compared between groups.Results:Mean age was 56.85±12.95 years. Mean vitamin D level was 21.19±13.93 ng/mL (2.5-83.5). Mean Qmax value was 35.41±12.63, whereas the mean Qav was 19.13±9.89, and the mean V was 446.60±165.08 mL. Vitamin D levels differed according to age groups (p=0.044). No significant difference was observed between groups according to Qmax, Qav and V values (p>0.05). No significant correlation was detected between vitamin D level and Qmax, Qav and V values. However, a negative correlation was detected between serum Ca level and V values (p=0.042) in the low vitamin D group.Conclusion:There was no direct relationship between vitamin D levels and LUTS in respect to uroflowmetry. However, we determined that Ca levels affect the uroflowmetry parameter in patients with low vitamin D levels. There is a need for further studies emphasizing serum Ca levels in addition to vitamin D levels in patients with LUTS.

Cranberry, D-mannose and anti-inflammatory agents prevent lower urinary tract symptoms in women undergoing prolapse surgery

Objective: We assessed the effect on lower urinary tract symptoms (LUTS) of a supplement containing cranberry, D-mannose and anti-inflammatory molecules in postmenopausal women undergoing surgery for cystocele.Study design: Forty postmenopausal women were randomized 1:1 to an active group receiving the nutritional supplement twice a day for 2 weeks starting from surgery, or to a control group receiving surgery only. Primary outcomes were the effectiveness in the postoperative LUTS and urinary tract infections (UTI). LUTS were investigated by a validated questionnaire (ICIQ-FLUTS) at baseline and at week 4. Secondary outcomes were the safety and tolerability of the supplement and other perioperative outcomes.Results: No significant differences were found in perioperative outcomes and in incidence of UTI. After surgery, women treated with the supplement experienced significantly better scores on the filling domain of the questionnaire. A non-significant decrease in voiding scores was also found. No adverse events were detected.Conclusion: The use of an oral supplement containing cranberry, D-mannose and anti-inflammatory molecules decreases the perception of LUTS in postmenopausal women after anterior colporraphy. Our data suggest that perioperative use of nutritional supplements may be useful in the management of postoperative LUTS.

Role and Place of Menopausal Hormone Therapy in Treatment of Symptoms of Lower Urinary Tracts in Women of 40+ Age

The objective: to evaluate the results of a comparative analysis of the clinical efficacy of various compositions, combination and pharmacological effects of drugs (antispasmodic, hormones, of plant origin) for symptoms of the lower urinary tract in women in the premenopausal period.Materials and methods. The efficacy of the treatment of 120 premenopausal women with symptoms of the lower urinary tract was studied. The complaints, uroflow metrics, sociological survey of results to identify the symptoms of menopausal syndrome by the MRS scale, as well as the level of anxiety by the S. Spielberg scale were evaluated as criteria for its assessment in the dynamics before and after 3, 6, 12 months. The data were statistically processed using Student’s and Fisher’s criteria.Results. There have been revealed the frequency and nature of complaints in women aged 40 plus, manifested in the form of urinary disorders, gynecological symptoms of menopausal syndrome. The results of treatment with the use of monotherapy with mirabegron, as well as in combination with menopausal hormone therapy (MHT) and herbal medicine, have been studied. There has been proven clinical advantage in treating women with genitourethral syndrome, using a combination of systemic MHT and symptomatic.Conclusions. Treatment of lower urinary tract symptoms in women of perimenopausal age with the presence of menopausal manifestations requires an integrated approach with the inclusion of systemic menopausal hormone therapy, among which objectively proven advantage of the drug, which includes levonorgestrel, as well as symptomatic therapy.