Urinary Tract Symptoms In Women Research Articles

Contemporary surgical management of female urethral stricture disease.

Female urethral stricture disease is increasingly recognized as an uncommon but important cause of lower urinary tract symptoms in women, which is amenable to surgical treatment. Several new reconstructive techniques have recently been described. The purpose of this review is to summarize the past literature with a focus on more recent contributions. Several new studies have recently been published investigating previously described reconstructive techniques including vaginal flap urethroplasty using the ventral approach, ventral labial graft, dorsal vaginal graft and dorsal buccal mucosal graft urethroplasty. Success rates, variably defined, ranged from 57.1 to 100% in these new contributions. No incidences of stress urinary incontinence were described. There continues to be lack of robust evidence to advocate one technique of urethroplasty for female urethral stricture disease over another, surgeon experience is likely to be an important factor. Urethroplasty using a flap or graft augmentation is a feasible treatment for female urethral strictures with good reported success rates and a minimal risk of stress of incontinence. Further studies are required to define the optimal technique and approach.

Non-drug treatment for lower urinary tract symptoms in women with voiding dysfunction

Non-drug treatment for lower urinary tract symptoms in women with voiding dysfunction

Effect of aging on urodynamic parameters in women with stress urinary incontinence.

Stress urinary incontinence (SUI) is one of the most common lower urinary tract symptoms in women. We analyzed age-associated changes in urodynamic parameters in women with SUI. We analyzed the urodynamic study (UDS) results of patients with urodynamically proven SUI between March 2008 and July 2014. In uroflowmetry, maximal flow rate (Qmax), time to Qmax, voided volume, and postvoid residual urine volume (PVR) and filling cystometry data including first, strong desire to void and Valsalva leak point pressure (VLPP) were measured. Also, Qmax and detrusor pressure at Qmax (Pdet@Qmax) of voiding cystometry data were analyzed. The subjects included 776 patients. Among the patients, 151 were withdrawn because of incomplete UDS data or because they met the exclusion criteria. A total of 625 patients enrolled in our study. The mean age of the population was 57.3 years. The mean Qmax, voided volume, voiding time, and PVR were 26.2 mL/s, 292.1 mL, 25.7 s, and 31.7 mL, respectively. Qmax (p=0.001) in uroflowmetry, PVR (p=0.042), first desire to void (p=0.042), Pdet@Qmax (p=0.016), and the bladder contractility index (p=0.046) were significantly different between the age groups. Qmax and Pdet@Qmax were decreased and PVR was increased significantly with age after 60 years. Older women with SUI also have worsened voiding function with age as the results of urodynamic parameters. Specifically, detrusor contractility decreased with age after 60 years.

Lower urinary tract symptoms in women with diabetes mellitus: a current review.

A literature review of the most current publications studying lower urinary tract symptoms (LUTS) and findings in diabetic women was conducted including articles from January 2013 to April 2014. Current reports consistently note that aging and obesity are significantly associated with worsened LUTS in diabetic women. Glucosuria has variable effects on urodynamic parameters and LUTS, but has a significant association with urinary tract infection (UTI) and incontinence at clinically relevant numbers, such as HbA1C values. The presence of severe nocturia in diabetic patients warrants careful surveillance for cardiovascular risks given the significant association with mortality. Diabetics appear to be at higher risk for colonization with the virulent, extended-spectrum, β-lactamase-producing Escherichia coli and Klebsiella species in UTI. Novel therapies in glycemic control and for diabetic bladder dysfunction are undergoing animal model trials with encouraging results. The most promising of these includes stem cell therapy, although a need exists for human studies.

Drug treatment for lower urinary tract symptoms in women with voiding dysfunction

Drug treatment for lower urinary tract symptoms in women with voiding dysfunction

MP76-08 SALIVARY CORTISOL RESPONSE TO STRESS IN WOMEN WITH OVERACTIVE BLADDER AND CONTROLS

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Non-neurogenic Voiding Dysfunction1 Apr 2014MP76-08 SALIVARY CORTISOL RESPONSE TO STRESS IN WOMEN WITH OVERACTIVE BLADDER AND CONTROLS Ariana Smith, Liisa Hantsoo, and C. Neill Epperson Ariana SmithAriana Smith More articles by this author , Liisa HantsooLiisa Hantsoo More articles by this author , and C. Neill EppersonC. Neill Epperson More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.2401AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Physiologic measures of stress response modulated by the hypothylamic pituitary axis may contribute to lower urinary tract symptoms in women with overactive bladder (OAB). METHODS Postmenopausal women age 45-75 diagnosed with OAB were recruited from a tertiary care Urology practice and age matched healthy controls were recruited from a research database. Participants were excluded if they were undergoing treatment for stress reduction, using anxiolytic or hormonal medications, reported pain, urinary infection, bladder cancer, or psychiatric disease. Salivary cortisol levels were obtained at baseline and at the time of induced psychosocial stress. The Trier Social Stress Test (TSST) was used as a motivated performance task for the induction of psychological stress. A two-day cortisol awakening response (CAR) and baseline salivary cortisol samples were obtained in all participants prior to TSST and at defined intervals post-TSST. Paired T-Tests were used to compare baseline cortisol (obtained 15 minutes before TSST) to stress response cortisol (obtained 50 minutes after TSST) in OAB patients and controls. RESULTS Eight patients with OAB and 5 controls completed the performance task and provided all requested salivary samples. No difference in CAR was detected between OAB women and controls. A trend toward greater physiologic responsiveness in women with OAB compared to controls was noted (Figure 1, p=0.066). CONCLUSIONS Women with OAB have similar baseline physiologic measures of stress response to controls. Women with OAB may have greater physiologic responsiveness to stress as measured by salivary cortisol following TSST. Evaluation of markers of stress response may provide targets for potential diagnostic and therapeutic interventions. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e884-e885 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Ariana Smith More articles by this author Liisa Hantsoo More articles by this author C. Neill Epperson More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Reproductive History and Progression of Lower Urinary Tract Symptoms in Women: Results From a Population-based Cohort Study

To examine whether reproductive history and related conditions are associated with the development and persistence of lower urinary tract symptoms (LUTS) other than urinary incontinence in a racially and/or ethnically diverse population-based sample of women. The Boston Area Community Health Survey enrolled 3201 women aged 30-79 years of black, Hispanic, or white race and/or ethnicity. Baseline and 5-year follow-up interviews were completed by 2534 women (conditional response rate, 83.4%). The association between reproductive history factors and population-weighted estimates of LUTS progression and persistence was tested using multivariable logistic regression models. Between baseline and 5-year follow-up, 23.9% women had LUTS progression. In age-adjusted models, women who had delivered ≥2 childbirths had higher odds of LUTS progression, but the association was completely accounted for by vaginal child delivery (eg, 2 vaginal childbirths vs none, multivariable-adjusted odds ratio = 2.21; 95% CI, 1.46-3.35; P <.001). No increased odds of LUTS progression were found for women with only 1 vaginal delivery or who only had cesarean section(s). Uterine prolapse was associated with higher odds of LUTS progression (multivariable-adjusted odds ratio = 3.05; 95% CI, 1.43-6.50; P = .004). Gestational diabetes was associated with approximately twice the odds of LUTS progression, but only among younger women (interaction P = .003). In this cohort study, ≥2 vaginal child deliveries, uterine prolapse, and among younger women, gestational diabetes were robust predictors of LUTS progression. Clinicians should assess the presence of bothersome urinary frequency, urgency, and voiding symptoms among women who have had multiple vaginal childbirths or gestational diabetes.

Chronic Lower Urinary Tract Symptoms in Women: Classification of Abnormalities and Value of Dedicated MRI for Diagnosis

Chronic lower urinary tract symptoms are common in women. We present a classification of abnormalities that can be considered in the differential diagnosis for lower urinary tract symptoms and can show the value of dedicated state-of-the art MRI in the workup of patients. Dedicated MRI tailored to patient symptoms and clinical findings has the potential to map out morphologic causes and categorize dysfunctional conditions from those that are truly nonmorphologic.

The 3-day bladder diary is a feasible, reliable and valid tool to evaluate the lower urinary tract symptoms in women

To evaluate the feasibility (% of completion), reliability (test-retest and inter-observer) and validity (convergent vs. questionnaires and vs. urodynamic study-UDS) of the 3-day bladder diary (3dBD) in women with lower urinary tract symptoms (LUTS). Epidemiological, descriptive, cross-sectional and prospective study. Fourteen Functional Urology and Urodynamic Units participated. One hundred thirty-six women with mean age (SD) 55.2 (13.8) years with LUTS, without bladder catheterization and who were able to fill in the 3dBD were included. An UDS was performed. They filled in the 3dBD in two times separated by 15 days (test and retest), the International Consultation on Incontinence-Short Form (ICIQ-UI SF) and the Bladder Control Self-Assessment Questionnaire (BSAQ). One hundred ten women completed 3dBD for test and retest. Feasibility: each 3dBD has 42 variables, 77.2% women completed 80%. Test-retest reliability: there were not differences in the proportion of patients classified as positive for each symptom (urgency: P = 0.3173; incontinence: P = 1; nocturia: P = 0.0522; frequency: P = 0.4386). The Intraclass Correlation Coefficient (ICC) ranged from 0.67 to 0.92, except for night time VVmax which was lower (0.54). Inter-observer reliability: ICC ranged from 0.64 to 0.99, except for day time VVmax (0.29) and the number of urgency episodes (0.45). Spearman correlation coefficients for ICIQ-UI SF and BSAQ ranged from 0.4 to 0.6 (P < 0.0001) and for UDS were lower (P < 0.05). The 3dBD showed good feasibility, reliability and validity to be used in the assessment of LUTS in women.

Urinary Incontinence Incidence: Quantitative Meta-Analysis of Factors that Explain Variation

We sought to explain variation in female age specific incidence rates for urinary incontinence using published, population based studies. We performed an extensive MEDLINE® review of published, population based studies of the female urinary incontinence incidence rate from 1966 to 2011 using a combination of symptom and epidemiological search terms. A total of 18 reports described 17 unique incidence studies. We abstracted the features of each study (eg sample size, followup, etc) along with detailed data on 109 age specific incidence rates (ie new cases per 1,000 person-years). Because the Nurses' Health Study had unique demographics and was dominant in sample size, analyses were completed with and without this study. Weighted (ie square root of sample size) linear regression was used to determine factors (ie age, source population, race, frequency score, etc) explaining variance among age specific incidence rates. Age and case definition accounted for 60% of the variation in incidence rates among studies. The age specific incidence was less than 2/1,000 person-years before age 40 years and it increased thereafter. For a given age group incidence rates varied as much as sixfold across studies, a finding that was largely explained by variation in case definition. The case definition accounts for substantial variation in urinary incontinence incidence estimates. Developing standards for reporting would provide a foundation for policy guidance and understanding etiology. We recommend that quantitative frequency criteria (eg 2 times or more per month) be reported vs vague thresholds (eg sometimes or often).

Lower urinary tract symptoms in women with benign joint hypermobility syndrome: a case–control study

Benign joint hypermobility syndrome (BJHS) is a connective tissue disorder associated with joint hypermobility. BJHS is under-recognised by medical professionals and is poorly managed. The aim of our study was to determine whether lower urinary tract symptoms (LUTS), including urinary incontinence (UI) and anterior compartment prolapse, are more common in women with BJHS than in the normal population. This was a prospective case-control study. Women diagnosed with BJHS according to the Brighton criteria were recruited from a tertiary referral clinic. Controls were recruited from hospital personnel. Both groups completed the King's Health Questionnaire (KHQ) and the Prolapse Quality of Life Questionnaire (P-QoL). Objective assessment of pelvic organ prolapse (POP) was undertaken using the Pelvic Organ Prolapse Quantification (POP-Q) system. Analyses were performed using SPSS version 17.0. The statistical difference was analysed using McNemar's test. Comparison of QoL scores was performed with the Wilcoxon signed-rank test. Sixty individuals were recruited and matched with 60 healthy women. The prevalence of UI in those with BJHS was significantly higher than in controls(73.3 % vs. 48.3 %). The impact of UI on QoL was statistically significant in all domains of the KHQ. There was a significant difference between groups in most urinary-specific symptoms of the KHQ. A significant number of women with BJHS suffer from voiding difficulties. Prolapse of the anterior vaginal wall was objectively more severe in those with BJHS. Women with BJHS have LUTS and anterior compartment prolapse, which significantly impair their QoL. It is important to identify women who are symptomatic. The addition of a systematic active case-finding approach may be more effective in identifying these cases.

Risks of Nocturia in Patients with Chronic Kidney Disease—Do the Metabolic Syndrome and its Components Matter?

We evaluate the risk factors for nocturia in patients with chronic kidney disease, and determine whether the metabolic syndrome and its components aggravate nocturia in these patients. We enrolled patients with chronic kidney disease who had regular followup at nephrology clinics, and excluded from study those patients undergoing dialysis, and those with neurogenic bladder or active urinary tract infection. Patients were asked to complete a questionnaire including medical history, clinical parameters and times of nocturnal voids in the last month. Laboratory parameters were checked when the questionnaire was completed. Clinically significant nocturia was defined as voiding 2 or more times per night. The metabolic syndrome was defined according to the ATP III (National Cholesterol Education Program Adult Treatment Panel III) guidelines. Chronic kidney disease was divided into 5 stages (based on National Kidney Foundation guidelines). Multivariate logistic regression was used to evaluate the risk factors for clinically significant nocturia. A total of 202 men and 234 women were eligible for analysis (mean age 68.4 years). The prevalence rate of clinically significant nocturia in patients with chronic kidney disease was 64.0%. Statistically significant risk factors for clinically significant nocturia were patient age (OR 1.02, 95% CI 1.003-1.04) and chronic kidney disease stage (OR 1.47, 95% CI 1.19-1.81) but not gender. Although 53.9% of our patients with chronic kidney disease had the metabolic syndrome, the metabolic syndrome (adjusted OR 0.96, 95% CI 0.64-1.44) and its components had no significant correlations with clinically significant nocturia. Clinically significant nocturia is prevalent in patients with chronic kidney disease, and the severity increased with chronic kidney disease stage and patient age. Contrary to previous reports, the metabolic syndrome did not increase the risk of clinically significant nocturia in patients with chronic kidney disease.

Lower urinary tract symptoms in women with vaginal agenesis

Congenital vaginal aplasia is a condition with devastating implications for fertility and sexuality. However, little is known on whether urinary symptomatology is more common prior and following vaginal lengthening procedures in these women. We performed a prospective observational study of 19 women with vaginal agenesis before and after vaginal dilation treatment or a laparoscopic Vecchietti procedure. All women completed the ICIQ FLUTS questionnaire before and after treatment in order to assess incidence and changes in urinary symptomatology. Urinary symptoms were present in 53% of women prior to treatment. The majority of bladder symptoms were not significantly altered by treatment, except for incomplete bladder emptying. Women following the Vecchietti procedure had increased urinary hesitancy and a poorer steam compared with those completing dilation treatment. The longer the vaginal length, the greater the urinary frequency. Women with vaginal agenesis had significant levels of urinary symptoms and to our knowledge this has not been reported before. The majority of symptoms were not altered by treatment.

Are Physical Activity, Smoking and Alcohol Consumption Associated with Lower Urinary Tract Symptoms in Men or Women? Results from a Population Based Observational Study

Lower urinary tract symptoms are highly prevalent and reduce quality of life. Lifestyle behaviors and the development of lower urinary tract symptoms have been largely unexamined. We investigated physical activity, smoking and alcohol drinking in relation to the development of lower urinary tract symptoms in men and women. Data were obtained from the BACH (Boston Area Community Health) Survey, a longitudinal observational study. Baseline (2002 to 2005) in-person interviews assessed activity, smoking and alcohol consumption. Five-year followup interviews (2006 to 2010 in 4,145) assessed new reports of moderate to severe lower urinary tract symptoms defined by the AUASI (AUA symptom index). Analysis was conducted using multivariable logistic regression. Lower urinary tract symptoms developed in 7.7% and 12.7% of at-risk men and women, respectively. Women were 68% less likely to experience lower urinary tract symptoms (OR 0.32; 95% CI 0.17, 0.60; p <0.001) if they had high vs low levels of physical activity. Although the association was similar among men, it was not statistically significant upon adjustment for medical or sociodemographic characteristics in the multivariable model. Women smokers were twice as likely to experience lower urinary tract symptoms, particularly storage symptoms (OR 2.15; 95% CI 1.30, 3.56; p = 0.003), compared to never smokers. Among men, smoking was not associated with lower urinary tract symptoms. Results for alcohol intake were inconsistent by intake level and symptom subtype. A low level of physical activity was associated with a 2 to 3 times greater likelihood of lower urinary tract symptoms. Smoking may contribute to the development of lower urinary tract symptoms in women but not in men. Clinicians should continue to promote physical activity and smoking cessation, noting the additional potential benefits of the prevention of lower urinary tract symptoms, particularly for women.

Lower urinary tract symptoms in women with and without urinary incontinence

Although most women are aware of the more severe end of the spectrum of urinary symptoms, incontinence, there are a myriad of other symptoms that can affect women's quality of life. The aim of this study is to compare lower urinary tract symptoms (LUTS) and associated factors in women with and without urinary incontinence. This descriptive study compared LUTS and associated factors between 367 incontinent and 401 continent women. LUTS were evaluated with Bristol Female Lower Urinary Tract Symptoms (BFLUTS) questionnaire. LUTS were more common among incontinent women with higher BFLUTS scores, indicating more severe complaints. Filling and voiding symptoms were also common among continent women. The most common symptoms in both groups were urgency, bladder pain, frequency, hesitancy and intermittency. Incontinent women with history of ≥4 pregnancy/birth and ≥4 kg fetus had the highest scores. Recurrent infection and flatus were associated with higher scores in both groups. History of diabetes, hypertension and haemorrhoid increased scores among continent women, while pulmonary disease was the only significant medical condition among incontinent women. Overweight and history of ≥10 kg weight gain were associated with higher scores among incontinent women. Women with ‘history of incontinence in mother’ had higher scores in continent women while ‘incontinence in relatives' had more significant effects on BFLUTS scores of incontinent women. LUTS with or without incontinence were common, especially in women with increased parity, high birth weight, chronic diseases diabetes, obesity and family history.

Dietary Macronutrient Intake and Lower Urinary Tract Symptoms in Women

To examine associations between macronutrient and total energy intakes with lower urinary tract symptoms (LUTS) in women. Cross-sectional analysis of 2060 women aged 30-79 years in the population-based Boston Area Community Health Survey (2002-2005). Data were collected by validated food frequency questionnaire and in-person interviews. Outcomes for multivariate logistic regression were moderate-to-severe total LUTS, storage, voiding, and postmicturition symptoms. Greater total energy intake was positively associated with LUTS, specifically among women with lower waist circumferences (<76 cm, p = .005, p(interaction) = .01). Increased saturated fat intake was associated with postmicturition symptoms (Quintile 5 vs. 1, odds ratio 3.94, 95% confidence interval 1.57-9.89, p(trend) = .04). High protein intake was positively associated with storage symptoms (p(trend) = .03), particularly nocturia. No consistent associations were observed for carbohydrate, monounsaturated, or polyunsaturated fat intakes. Among women with low waist circumferences, high total daily calorie intake was associated with moderate-to-severe LUTS. Although greater saturated fat intake was linked to postmicturition symptoms, the possibility that postmicturition symptoms in women represent more extensive or severe conditions should be explored in future research. These novel results indicate that dietary contributors to LUTS in women are distinct from those in men and may depend on symptom subtype and body size.

Lifestyle changes for the prevention and management of lower urinary tract symptoms in women

Lower urinary tract symptoms (LUTS) are highly prevalent conditions with a profound influence on the well-being and quality of life. Patients should receive counselling on the behavioural changes for promoting healthy lifestyle in the prevention and optimal treatment of LUTS. In obese women, weight loss should be advised as one of the first-step interventions. Smoking cessation is recommended considering the relationship between smoking and lower urinary tract complaints in addition to its general health risks. Caffeine consumption should be limited to <200 mg/d (two cups of coffee) because of its potential effects on urgency and frequency of symptoms. The products which are thought to be bladder irritants should be removed one by one from the diet, and the change in the symptoms must be monitored separately for some time. Fluid intake restriction in the evening can be useful especially in the elderly women. The amount of daily fluids should be approximately 30 mL/kg (eight cups) according to the body weight. Changing high-impact exercise with low-impact exercise and avoiding activities that require recurrent, chronic intra-abdominal pressure may be useful especially in stress incontinence. Dietary changes and other recommendations for maintaining healthy bowel movements should be provided for the prevention of constipation. In conclusion, using lifestyle changes is viewed effective and recommended to be used to treat urinary incontinence, especially in combination with other behavioural techniques.

Lower urinary tract symptoms in women and quality of life

Lower urinary tract symptoms (LUTSs) are the most common symptoms in women at all age groups worldwide, and their prevalence is increasing with age. LUTSs have a multifactorial status. The risk factors are age, race, pregnancy, birth, menopause, hysterectomy, obesity, chronic cough, depression, profession and family history. LUTSs have negative effects on women's quality of life, especially on the medical, physical, social, psychological, economical and sexual aspects. Studies report a relationship between the sexual dysfunction and urogynaecological diseases. Although the pathophysiology of high prevalence of sexual dysfunction in women with LUTS is not well known, it is estimated that the LUTS and sexual dysfunction occur due to the effects of low oestrogen levels on vagina, urethra, trigone epithelium and the atrophy of pelvic floor muscles. Especially women, who experience urinary incontinence (UI) and subgroup problems, report more common sexual dysfunctions (hypoactive sexual desire disorder, very urgent need for urination during the sexual intercourse and leakage, lack of sexual arousal, orgasm problems, sexual pain disorders). Despite the high prevalence of LUTS and its negative effects on the quality of life, the help‐seeking behaviours of women for overcoming LUTS differ according to the level of disturbance. Nurses should cooperate with other health care personnel in LUTS prevention, diagnosis, treatment/follow‐up, in the diagnosis of sexual dysfunction due to LUTS and its management. This article discusses the prevalence of LUTS, the risk factors of LUTS, the quality of life of women with LUTS, the negative effects of LUTS on sexual life and its nursing care.

UP-1.26: The role of alpha 1(A) Adrenoceptor antagonist tamsulosin for the treatment of patients with lower urinary tract symptoms in women: the effect of nocturia and sleep quality

UP-1.26: The role of alpha 1(A) Adrenoceptor antagonist tamsulosin for the treatment of patients with lower urinary tract symptoms in women: the effect of nocturia and sleep quality

UP-1.10: Urinary incontinence in obese people: urodynamics studies

The purpose of this study was to describe urodynamic characteristics of obese women with urinary incontinence. We investigated whether BMI is associated with lower urinary tract symptoms in women.