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Hou J, Zhao Y, Zhuang S, Ma X, Hou Y, Li X, Wang Y. Visit rates and risk factors of healthcare-seeking behavior for urinary incontinence, fecal incontinence, and pelvic organ prolapse among women: A systematic review and meta-analysis. Geriatr Nurs 2025; 63:307-319. [PMID: 40239392 DOI: 10.1016/j.gerinurse.2025.03.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2024] [Revised: 02/02/2025] [Accepted: 03/31/2025] [Indexed: 04/18/2025]
Abstract
INTRODUCTION Female pelvic floor dysfunction(FPFD), including urinary incontinence, fecal incontinence, and pelvic organ prolapse, is an expanding global health problem among women, declining their quality of life. Healthcare-seeking behavior of FPFD patients plays a vital role in preventing symptom deterioration and reducing future burdens. Poor healthcare-seeking behavior has resulted in lower visit rates than prevalence. This study aimed to investigate the visit rate and risk factors of healthcare-seeking behavior in patients with FPFD and to provide a basis for developing prevention strategies against risk factors. METHODS An exhaustive systematic literature search was undertaken using the following databases: PubMed, Web of Science, Embase, The Cochrane Library, and CINAHL, published from inception to June 2022. Two investigators independently extracted data and assessed the quality of the studies using the Health Care Quality and Research (AHRQ) or Newcastle-Ottawa Scale (NOS). A meta-analysis was performed by using Review Manager 5.3. RESULTS Eighty studies were selected, including 83,996 participants. Data were extracted from 71 studies for urinary incontinence, 5 for pelvic organ prolapse, and 4 for fecal incontinence. Meta-analysis results indicated that the visit rates of urinary incontinence, pelvic organ prolapse, and fecal incontinence were lower, at 29%(95%CI:27% to 32%, I2=99%, P<0.00001), 42%(95%CI:18% to 65%, I2=99%, p=0.0005), and 35%(95%CI:16% to 54%, I2=99%, p=0.0004), respectively. The study shows that there are a variety of factors affecting the healthcare-seeking behavior of FPFD women, including sociodemographic factors(treatment and diagnosis costs are high, lack of time, type of UI, duration of UI, symptom severity, and impact of UI), psychological factors(shame, fear of medical treatment side effects, fear of examination, and fear of surgery), cognitive factors(considering it as the normal status of aging, the perception that symptoms are not treatable, believing that symptoms could recover naturally, lack of knowledge of available treatment, believing they should cope with the problem themselves, do not think it is serious enough), healthcare service factors(the physician said it was not necessary, other health problems taking priority). Age, fear of hospitals/doctors, and fear of diagnosis do not affect healthcare-seeking behavior. CONCLUSION Patients with urinary incontinence, pelvic organ prolapse, and fecal incontinence have a low visit rate. Many risk factors affect the healthcare-seeking behavior of female pelvic floor dysfunction diseases, mainly sociodemographic, psychological, cognitive, and healthcare service factors. However, due to a lack of data, high-quality studies are still required to confirm. In the future, attention should be paid to policy guidance and ethical changes, strengthening the training of medical personnel and comprehensive medical education on the diagnosis, treatment and management of FPFD as well as appropriate nursing pathways. In addition, public information campaigns on the comprehensive prevention of FPFD should be strengthened to raise women's awareness of the comprehensive prevention of FPFD, especially health education.
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Affiliation(s)
- Jiawen Hou
- School of Nursing, Lanzhou University, Lanzhou, Gansu, 730011, China; Fengxian People's Hospital, Xuzhou, Jiangsu, 221000, China
| | - Yanan Zhao
- School of Nursing, Lanzhou University, Lanzhou, Gansu, 730011, China
| | - Simin Zhuang
- School of Nursing, Lanzhou University, Lanzhou, Gansu, 730011, China
| | - Ximei Ma
- School of Nursing, Lanzhou University, Lanzhou, Gansu, 730011, China
| | - Yijing Hou
- Fengxian People's Hospital, Xuzhou, Jiangsu, 221000, China
| | - Xiuling Li
- Fengxian People's Hospital, Xuzhou, Jiangsu, 221000, China
| | - Yanhong Wang
- School of Nursing, Lanzhou University, Lanzhou, Gansu, 730011, China.
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Kovacevic S, Vukovic I, Bumbasirevic U, Zivkovic M, Savic S, Bukumiric Z, Panajotovic N, Bulat P, Cegar B. Cross-Cultural Adaptation and Validation of Incontinence Outcome Questionnaire for Serbian Population. MEDICINA (KAUNAS, LITHUANIA) 2025; 61:509. [PMID: 40142320 PMCID: PMC11944165 DOI: 10.3390/medicina61030509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2025] [Revised: 03/09/2025] [Accepted: 03/13/2025] [Indexed: 03/28/2025]
Abstract
Background and Objectives: Stress urinary incontinence (SUI) impacts 4-50% of adult women, frequently resulting in embarrassment, diminished self-esteem, and social withdrawal, significantly affecting quality of life. The aim of our study is to cross-culturally adapt and validate the Urinary Incontinence Outcome Questionnaire (IOQ) for the Serbian population and to assess the multifaceted impact of SUI on the quality of life among women. Materials and Methods: A cross-sectional study involved a total of 150 women: 100 undergoing surgical management for SUI (ST group) and 50 receiving non-surgical treatments, including vaginal estrogen, pessaries, electrical stimulation, or collagen fillers (NST group). The participants completed questionnaires on demographics, fatigue (MFI), anxiety and depression (HADS), and quality of life (SF-36), as well as the IOQ. Results: The ST group had a mean age of 60.0 ± 10.0 years, with 65% married, 65% with secondary education, 62% non-smokers, and 78% with comorbid conditions, primarily cardiovascular disease (59%). The NST group showed similar characteristics, with a significant difference in cardiovascular comorbidity (p = 0.049). All IOQ subscales demonstrated good internal consistency (Cronbach alpha > 0.7), except for the subscale Complications (Cronbach alpha = 0.440). The IOQ score for "Symptoms pre-operative" had the highest mean value (62.8 ± 18.6), while "Hospital Re-admission" had the lowest (303 ± 17.1). A comparison of the SF-36 scores showed significant differences in the Energy (p = 0.025) and Emotional well-being (p = 0.015) domains between the ST and NST groups. Conclusions: The Serbian version of the IOQ has been validated, demonstrating psychometric features that endorse its application in clinical and research contexts. This study highlights the significant impact of SUI on quality of life and the need for a comprehensive approach to treatment. The results emphasize the importance of addressing both the physical and psychological aspects of SUI to improve the lives of affected women.
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Affiliation(s)
| | - Ivan Vukovic
- Clinic of Urology, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (I.V.); (U.B.); (M.Z.); (P.B.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia;
| | - Uros Bumbasirevic
- Clinic of Urology, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (I.V.); (U.B.); (M.Z.); (P.B.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia;
| | - Marko Zivkovic
- Clinic of Urology, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (I.V.); (U.B.); (M.Z.); (P.B.)
| | - Slavisa Savic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia;
- Department of Urology, KBC Dr. Dragiša Mišovic, 11000 Belgrade, Serbia
| | - Zoran Bukumiric
- Institute of Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia;
| | | | - Petar Bulat
- Clinic of Urology, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (I.V.); (U.B.); (M.Z.); (P.B.)
| | - Bojan Cegar
- Clinic of Urology, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (I.V.); (U.B.); (M.Z.); (P.B.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia;
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Warner KJ, Schultz AA, Barnet JH, Brown HW. Urinary Incontinence and Care Seeking Among Wisconsin Women. UROGYNECOLOGY (PHILADELPHIA, PA.) 2025; 31:139-146. [PMID: 39841520 DOI: 10.1097/spv.0000000000001599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2025]
Abstract
IMPORTANCE Women who identify as Black or African American are underrepresented in research about pelvic floor disorders. OBJECTIVES The objectives of this study were to describe the prevalence of and factors associated with urinary incontinence (UI) and UI care-seeking among adult women in a Wisconsin household survey. STUDY DESIGN This was a cross-sectional analysis of data collected by the Survey of the Health of Wisconsin (SHOW). Using community engagement, individuals who identified as Black or African American were purposively oversampled in the 2018-2019 wave. Descriptive analyses compared women with and without UI, and those who had and had not sought care. RESULTS Among 237 study participants, 46% (110) had UI: 46% mild, 36% moderate, and 18% severe. Most participants (84%) self-identified as non-Hispanic Black (84%), with a mean age of 49 ± 16 years and mean body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) of 34 ± 9; 62% were insured by Medicaid. The prevalence of UI was 44% among women who identified as non-Hispanic Black versus 59% (P = 0.085) among other women. Older age, obesity, needing help to read medical instructions, and identifying as a race other than non-Hispanic Black were significantly associated with UI. Among 110 women with UI, 53% had previously sought care. Rates of UI care seeking were similar (P = 0.32) among women who identified as non-Hispanic Black (55%) and those who identified as another race or ethnicity (43%). CONCLUSION Needing help to read medical instructions emerged as a factor associated with UI diagnosis in this sample that included almost 200 women who identified as non-Hispanic Black.
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Affiliation(s)
| | | | - Jodi H Barnet
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI
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Sanaeifar N, Buch T, Debler M, Kesselmeier R, Canales S, Meer M. Exploration of user satisfaction in using the newly redesigned MoliCare Premium Men Pad: in-home use study. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2024; 33:S22-S27. [PMID: 39392330 DOI: 10.12968/bjon.2024.0296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/12/2024]
Abstract
BACKGROUND Men frequently underestimate the significance of urinary incontinence and fail to disclose their condition owing to embarrassment and the associated social stigma. Therefore, successful incontinence management with absorbent products helps individuals cope with the emotional and social challenges arising from incontinence, including visible urine leakage, frequent urination, unpleasant odours, and isolation. AIM To assess the most essential performance features of the newly developed MoliCare Premium Men Pad. METHODS Computer-assisted personal interviews were conducted to obtain the opinions and satisfaction levels of 69 male users with incontinence in Germany regarding different performance characteristics of the newly designed MoliCare Premium Men Pad after using the product. FINDINGS All performance characteristics of the new MoliCare Premium Men Pad design received positive ratings from all interviewees. Notably, 90% of participants were 'highly satisfied' and 'satisfied' with the new MoliCare design. CONCLUSIONS The new MoliCare SkinGuard absorbent core technology, anti-leakage guards, and well-engineered product design provide protection, discretion, and comfort to individuals with incontinence. The newly developed MoliCare Premium Men Pad is specifically tailored to meet the primary needs of male pad users and help them maintain a normal lifestyle.
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Olagundoye O, Gibson W, Wagg A. A protocol for the co-creation and usability/acceptability testing of an evidence-based, patient-centred intervention for self-management of urinary incontinence in older men. PLoS One 2024; 19:e0306080. [PMID: 39133744 PMCID: PMC11318901 DOI: 10.1371/journal.pone.0306080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Accepted: 07/29/2024] [Indexed: 08/15/2024] Open
Abstract
Male urinary incontinence (UI) is most prevalent in older men, with one in three men aged 65 and above having problems maintaining continence. Addressing health inequalities, male-female disparities in continence services, and low health-seeking among men emphasizes the necessity for co-creating an intervention that empowers them to self-manage their UI. We aim to co-create a self-management intervention with an older men and Health care provider (HCP) group and assess its usability and/or acceptability among older men with UI. The intervention mapping (IM) framework, a co-creation strategy, will be used to co-create a self-management tool, followed by usability and/or acceptability testing. The study will be guided by the first four IM steps: the logic model of the problem, the logic model of change, program/intervention design, and program/intervention production, followed by preliminary testing. A participatory group of older men with UI recruited from an existing group of patient partners, and continence care experts will be involved in all steps of the IM process. Usability and/or acceptability testing will be conducted on a sample of 20 users recruited through seniors' associations and retirement living facilities. After accessing the self-management tool for a week, participants will complete a product usability testing scale (aka System Usability Scale-SUS) and/or an acceptability test, depending on the preferred mode(s) of intervention delivery. Data will be analyzed using descriptive statistics. A benchmark overall mean usability score of 70 represents a good/usable product, based on the large database of SUS scores.
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Affiliation(s)
- Olawunmi Olagundoye
- Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine & Dentistry, College of Health Sciences, University of Alberta, Edmonton, AB, Canada
| | - William Gibson
- Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine & Dentistry, College of Health Sciences, University of Alberta, Edmonton, AB, Canada
| | - Adrian Wagg
- Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine & Dentistry, College of Health Sciences, University of Alberta, Edmonton, AB, Canada
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Kasoff M, Alishahian L, Gimoto J, Steinhart A, Grimes CL, Pape DM. Mobile Phone Apps for Pelvic Floor Disorders. UROGYNECOLOGY (PHILADELPHIA, PA.) 2024:02273501-990000000-00261. [PMID: 39159315 DOI: 10.1097/spv.0000000000001541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/21/2024]
Abstract
IMPORTANCE Up to 50% of patients report not readily seeking treatment for pelvic floor disorders (PFDs). The increase in phone applications (apps) for health care information is an opportunity to increase access to care. OBJECTIVE The aim of the study was to systematically evaluate content and function of apps for patients with PFDs. STUDY DESIGN Apps were screened using PFD-related search terms. Included apps were on the Apple store, in English, and targeted patients with PFDs. The primary outcome was app quality based on the APPLICATIONS scoring system (scored 0-16). Secondary outcomes included professional medical involvement, iTunes rating details, the presence of a voiding/bowel diary, tracking of diet, pain/symptoms, exercise, and medication, graphing or social functions, reminders, disease information, and decision support. Data was reported with descriptive statistics (medians (ranges) and n (percentages). RESULTS Eight hundred forty apps were identified and 83 were analyzed. The top 3 PFD categories represented were defecatory dysfunction (29), overactive bladder (28), and stress incontinence (27). The median APPLICATIONS score was 7 (3-12). Most apps (78%) were developed without professional medical involvement. Most apps were free, while the remainder ranged from $1.99 to $4.99. No app had all features. Twenty-five apps (30%) included a voiding diary, 33 (40%) had a bowel diary, 27 (33%) included exercise tracking, and 44 (53%) had reminder systems. CONCLUSIONS Most apps had reasonable, but not high, functionality. Current apps provide varying degrees of overall utility, with limited disease information and decision support. Further collaboration with medical providers in app development would support better integration of clinician and patient needs.
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Pancheshnikov A, Harrington BJ, Handa VL, Yanes LI, Le Neveu M, Voegtline KM, Olson SB, Blomquist JL, Jacobs S, Patterson D, Chen CCG. Urinary Incontinence Care-Seeking Barriers Among Latina Patients: What Are We Missing? UROGYNECOLOGY (PHILADELPHIA, PA.) 2024:02273501-990000000-00255. [PMID: 39074354 DOI: 10.1097/spv.0000000000001555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/31/2024]
Abstract
IMPORTANCE The Latina population is the largest growing ethnic group in the United States with high levels of health disparities in urinary incontinence (UI) treatment and complications rates, which may be due to disproportionately high barriers to UI care-seeking among Latinas. OBJECTIVES The objectives of this study were to compare barriers to UI care-seeking among Latina, non-Latina Black, and non-Latina White patients by utilizing the Barriers to Incontinence Care Seeking Questionnaire (BICS-Q) total scores, and to compare specific barriers utilizing BICS-Q subscales. STUDY DESIGN In this cross-sectional study, patients accessing primary care were recruited to complete the BICS-Q, International Consultation on Incontinence Questionnaire-Short Form, and Prolapse and Incontinence Knowledge Questionnaire-Urinary Incontinence. The BICS-Q total and subscale scores were compared among ethnic/racial groups. RESULTS A total of 298 patients were included in the study with 83 Black, 144 Latina, and 71 White participants per self-identified ethnicity/race. The total BICS-Q score was highest for Latina participants, followed by White and Black participants (11.2 vs 8.2 vs 4.9, respectively, P < 0.0001). Latina participants had significantly higher BICS-Q subscale scores compared with Black participants with no significant differences between Latina and White participants. After controlling for potential confounders, Latina ethnicity/race was still associated with a higher BICS-Q score when compared to Black ethnicity/race (P = 0.0077), and lower Prolapse and Incontinence Knowledge Questionnaire-Urinary Incontinence scores remained independently associated with higher BICS-Q scores (P = 0.0078). CONCLUSIONS In our study population, Latina patients and patients with lower UI knowledge experience higher barriers to UI care-seeking compared with Black patients and patients with higher UI knowledge. Addressing these barriers may increase care-seeking and improve health equity in the field.
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Affiliation(s)
- Anna Pancheshnikov
- From the Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Bryna J Harrington
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Victoria L Handa
- From the Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Liz I Yanes
- Universidad Iberoamericana UNIBE, Santo Domingo, Dominican Republic
| | - Margot Le Neveu
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Sarah B Olson
- Biostatistics, Epidemiology and Data Management (BEAD) Core, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Joan L Blomquist
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Gynecology, Greater Baltimore Medical Center, Baltimore, MD
| | - Stephanie Jacobs
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Gynecology, Greater Baltimore Medical Center, Baltimore, MD
| | - Danielle Patterson
- From the Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Chi Chiung Grace Chen
- From the Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD
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Patel UJ, Moureau MK, Neuner JM, Brown HW. Screening and Treating Urinary Incontinence in Primary Care: A Missed Opportunity. OBM GERIATRICS 2023; 7:252. [PMID: 38567050 PMCID: PMC10986360 DOI: 10.21926/obm.geriatr.2304252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
More than 60% of adult women in the United States have urinary incontinence (UI), with the prevalence increasing to over 80% in women over age 65. Despite its high prevalence, most patients do not seek care and few clinicians screen for UI. The Medicare Health Outcomes Survey queries patients about satisfaction with their provider's discussion and management of UI, but formal recommendations about screening, diagnosis, and treatment are lacking. This review presents a practical algorithm for primary care providers to incorporate management of UI into routine preventive care for women, and outlines UI prevalence, risk factors, screening, and non-surgical treatment options.
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Affiliation(s)
- Ushma J Patel
- University of Wisconsin School of Medicine and Public
Health, Department of Obstetrics and Gynecology, 1010 Mound Street 4th floor,
Madison, WI, USA
| | - Madeline K Moureau
- University of Wisconsin School of Medicine and Public
Health, Department of Obstetrics and Gynecology, 1010 Mound Street 4th floor,
Madison, WI, USA
| | - Joan M Neuner
- Medical College of Wisconsin, Division of General Internal
Medicine, Milwaukee, WI, USA
| | - Heidi W Brown
- Kaiser Permanente, Department of Obstetrics and
Gynecology, 3250 Fordham Street, San Diego, CA, USA
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Zhang Y, Hou S, Qi Z, Wu S, Zhu K, Wang W. Non-pharmacological and nonsurgical interventions in male urinary incontinence: A scoping review. J Clin Nurs 2023; 32:6196-6211. [PMID: 37161602 DOI: 10.1111/jocn.16749] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 04/10/2023] [Accepted: 04/25/2023] [Indexed: 05/11/2023]
Abstract
AIMS To describe and synthesize non-pharmacological and nonsurgical interventions for male urinary incontinence from the existing literature. METHODS A scoping review was conducted following the methodology suggested by Arksey and O'Malley: (1) identification of the research questions; (2) identification of relevant studies using a three-step search recommended by JBI: an initial search within PubMed and CINAHL, a comprehensive literature search within PubMed, CINAHL, EMBASE, PsycINFO, Cochrane Library, and literature search of references lists; (3) study selection; (4) data extraction and charting; (5) collation, summarization, and reporting of the results. The PRISMA-ScR Checklist was used to report. RESULTS A total of 4602 studies were identified, of which 87 studies were included. Approximately 78% were randomized controlled trials. More than 88% of the participants were men with prostate cancer. Exercising pelvic floor muscles 30 times per day for 12 weeks was the most frequently reported. Parameters of electrical stimulation were typically set up to 50 Hz and 300 μs for frequency and width of pulse, respectively, and lasted for 15 min. Pure pelvic floor muscle training, Pilates, Yoga, whole body vibration, diaphragm/abdominal muscle training, micturition interruption exercise, acupuncture, and auriculotherapy showed positive effects on reducing urinary incontinence. CONCLUSION The findings suggested implementing pelvic floor muscle training alone before or after surgery can both prompt the recovery of continence in men after prostate cancer surgery. The decision to use biofeedback or electrical stimulation to enhance the therapeutic effect of pelvic floor muscle training should be approached with caution. More rigorous designed studies are needed to validate the effectiveness of Traditional Chinese Medicine techniques and diverse novel methods. RELEVANCE TO CLINICAL PRACTICE Physicians and nurses need to be up to date on the latest evidence-based non-pharmacological and nonsurgical interventions in male urinary incontinence and select appropriate interventions based on available medical resources and patient preferences.
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Affiliation(s)
- Ying Zhang
- Department of Nursing, The First Affiliated Hospital, Zhejiang University School of Medicine, Shangcheng District, Hangzhou, China
- Zhejiang University School of Medicine, Shangcheng District, Hangzhou, China
| | - Sijia Hou
- Department of Nursing, The First Affiliated Hospital, Zhejiang University School of Medicine, Shangcheng District, Hangzhou, China
- Zhejiang University School of Medicine, Shangcheng District, Hangzhou, China
| | - Ziyi Qi
- Department of Nursing, The First Affiliated Hospital, Zhejiang University School of Medicine, Shangcheng District, Hangzhou, China
- Zhejiang University School of Medicine, Shangcheng District, Hangzhou, China
| | - Siyuan Wu
- Department of Nursing, The First Affiliated Hospital, Zhejiang University School of Medicine, Shangcheng District, Hangzhou, China
- Zhejiang University School of Medicine, Shangcheng District, Hangzhou, China
| | - Keping Zhu
- Department of Nursing, The First Affiliated Hospital, Zhejiang University School of Medicine, Shangcheng District, Hangzhou, China
| | - Wei Wang
- Department of Nursing, The First Affiliated Hospital, Zhejiang University School of Medicine, Shangcheng District, Hangzhou, China
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Evaluation of urinary continence status and its influence on quality of life after gyneco-oncological treatment of female pelvic malignancies at an oncological center. BMC Womens Health 2022; 22:422. [PMID: 36284341 PMCID: PMC9594888 DOI: 10.1186/s12905-022-01999-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 10/04/2022] [Indexed: 11/07/2022] Open
Abstract
Urinary incontinence (UI) could negatively affect a person's quality of life (QoL). This study investigates the association among gynecological cancers, their treatments, UI, and its effect on the QoL of survivors of gynecological cancer. This cross-sectional questionnaire-based study included 121 cases from 405 patients who had undergone gyneco-oncological therapy. The participants were asked whether they experienced any form of UI and whether it impacted their QoL. The following therapies were used to treat the 12 gynecologic tumor types found in the participants: surgery (n = 116, 95.87%), chemotherapy (CTx) (n = 51, 42.2%), radiotherapy (RTx) (n = 31, 25.6%), and antibody therapy (ABT) (n = 11, 9.1%). No significant association was determined between tumor type and UI. However, body mass index (BMI), radical hysterectomy, vulvar or vaginal surgery, and presence of UI before treatment had significant impacts on the presence of UI. The surgical access routes, CTx, ABT, and hysterectomy had significant impacts on the severity of UI after treatment. Among all patients, 55.4% reported very good QoL. These reports of good QoL by patients could be due to their very good adjustment to the situation, with regard to being diagnosed with and receiving treatment for cancer, or due to the patients considering UI to not be much of an issue. Additionally, 34% of patients reported they had not been informed about the risk of UI before treatment. Informing patients about UI as one of the risks of therapy before initiating the treatment is crucial as patients who had been informed beforehand coped with UI far better than those who were not informed. Hence, the treatment of UI is often successful, so patients should be encouraged to receive urogynecological consultation.
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Reddy D, Zulfeen M, Pandey D. Stress incontinence combined score (SICS): A novel combined grading system to assess the severity of stress urinary incontinence in women. Eur J Obstet Gynecol Reprod Biol 2022; 278:57-65. [PMID: 36115261 DOI: 10.1016/j.ejogrb.2022.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 08/24/2022] [Accepted: 09/02/2022] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Natural history of urinary incontinence (UI) in women is a less understood domain. Stratifying severity of stress urinary incontinence (SUI) can be an important tool to understand the natural history, prognosticate the disease and plan optimal management. Present study was aimed to test a novel score (Stress Incontinence Combined score: SICS) with the currently popular tools International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) and Incontinence Symptom Index (ISI) scores. MATERIAL AND METHODS This was a prospective study conducted at a university teaching hospital, over a period of 2 years. After screening women for SUI, SICS was administered. The novel SICS score was then compared with ICIQ-UI SF and ISI. RESULTS A total of 1750 women, attending various OPDs in a tertiary care hospital, were screened for urinary incontinence. The prevalence of UI and SUI was 26.6% and 12.8% respectively. The agreement between ISI and SICS was 81.7%, while the ICIQ- UI SF agreed with the SICS in 80.8% of the cases. AUROC analysis done showed that a score of 10 or more on the SICS (total score 16) could diagnose high-grade SUI with a sensitivity of 97%, specificity of 96% (Reference: ISI), and a sensitivity of 100%, and specificity of 93% (Reference: ICIQ- UI SF) CONCLUSION: SICS is the first of its kind tool, developed to specifically grade the severity of SUI, while incorporating both subjective and objective measures, with excellent reliability and reproducibility.
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Affiliation(s)
- Deepa Reddy
- KMC Manipal, Manipal Academy of Higher Education, Manipal (MAHE), India
| | | | - Deeksha Pandey
- KMC Manipal, Manipal Academy of Higher Education, Manipal (MAHE), India.
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Patel UJ, Godecker AL, Giles DL, Brown HW. Updated Prevalence of Urinary Incontinence in Women: 2015-2018 National Population-Based Survey Data. Female Pelvic Med Reconstr Surg 2022; 28:181-187. [PMID: 35030139 DOI: 10.1097/spv.0000000000001127] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES This study aimed to update estimates of urinary incontinence (UI) prevalence and associated risk factors for adult women in the United States, using the National Health and Nutrition Examination Survey (NHANES). METHODS We used descriptive analysis of 2015-2018 NHANES weighted data for women to estimate prevalence and characterize UI types and severity. Logistic regression modeling determined adjusted associations with UI. RESULTS Complete data were available for 5,006 women. In weighted analyses, 61.8% had UI, corresponding to 78,297,094 adult U.S. women, with 32.4% of all women reporting symptoms at least monthly. Of those with UI, 37.5% had stress urinary incontinence, 22.0% had urgency urinary incontinence, 31.3% had mixed symptoms, and 9.2% had unspecified incontinence. The prevalence of moderate or more severe UI by Sandvik Severity Index was 22.1%, corresponding to 28,454,778 adult U.S. women. In multivariate models, increasing age, body mass index ≥25, prior vaginal birth, anxiety, depression, functional dependence, and non-Hispanic White ethnicity and race were associated with any and moderate UI. Urinary incontinence was not associated with diabetes, education level, prior hysterectomy, smoking status, physical activity level, or current pregnancy status. CONCLUSIONS More than 60% of community-dwelling adult women in the United States experience any UI and an increase from prior estimates (38%-49%) using NHANES data from 1999 to 2004; more than 20% experience moderate or more severe UI. Increases in UI prevalence may be related to population aging and increasing obesity prevalence. Age greater than 70 years, body mass index >40, and vaginal birth had the strongest association with UI in multivariate modeling.
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Affiliation(s)
- Ushma J Patel
- From the Department of Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health (UW SMPH), Madison, WI
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13
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Akbar A, Liu K, Michos ED, Bancks MP, Brubaker L, Markossian T, Durazo-Arvizu R, Kramer H. Association of Overactive Bladder With Hypertension and Blood Pressure Control: The Multi-Ethnic Study of Atherosclerosis (MESA). Am J Hypertens 2022; 35:22-30. [PMID: 33899909 DOI: 10.1093/ajh/hpaa186] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 10/20/2020] [Accepted: 04/06/2021] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND The sudden urge to urinate, also known as overactive bladder (OAB), may reflect higher sympathetic activity and associate with higher blood pressure (BP). METHODS This cross-sectional analysis utilized data from sixth follow-up exam (2015-2016) of Multi-Ethnic Study of Atherosclerosis to examine the association of OAB with systolic (SBP) and diastolic blood pressure (DBP) levels, hypertension, and BP control. Information on urinary symptoms was obtained with the International Consultation on Incontinence Questionnaire (ICIQ). Sex-stratified regression models were constructed to examine differences in BP, hypertension prevalence, and BP control while adjusting for demographic factors, comorbidities, and medication use. RESULTS Among the 1,446 men and 1,628 women who completed the ICIQ (mean age 73.7 years [SD 8.4]), OAB was present in 31.6% of men and 38.9% of women. With no antihypertensive medication use, OAB was not associated with SBP or DBP in both men and women after adjusting for covariates. However, among the 894 men and 981 women on antihypertensive medication, OAB was associated with higher SBP among men (4.04 mm Hg; 95% confidence interval [CI] 1.02, 7.06) but not among women (-0.67 mm Hg; 95% CI -3.79, 2.46) while DBP did not differ by OAB presence in men or women. In addition, OAB was also associated with lower odds of BP control among men (odds ratio [OR] 0.69; 95% CI 0.49, 0.96) but not women (OR 0.96; 95% CI 0.71, 1.30). CONCLUSIONS Among men, OAB is associated with lower odds of BP control which suggests that OAB may impede hypertension management.
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Affiliation(s)
- Aelia Akbar
- Department of Public Health Sciences, Loyola University Chicago, Maywood, Illinois, USA
| | - Kiang Liu
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Erin D Michos
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Michael P Bancks
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Linda Brubaker
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Diego, La Jolla, California, USA
| | - Talar Markossian
- Department of Public Health Sciences, Loyola University Chicago, Maywood, Illinois, USA
| | - Ramon Durazo-Arvizu
- Department of Public Health Sciences, Loyola University Chicago, Maywood, Illinois, USA
| | - Holly Kramer
- Department of Public Health Sciences, Loyola University Chicago, Maywood, Illinois, USA
- Department of Medicine, Loyola University Chicago, Maywood, Illinois, USA
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14
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Kelly AM, Keenan P. Urinary incontinence and the impact on migrant individuals with intellectual disability. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2021; 30:S30-S38. [PMID: 34645335 DOI: 10.12968/bjon.2021.30.18.s30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Enhancing and enriching the health and wellbeing of migrant individuals with intellectual disability is essential in our diverse society. The needs of this population can be substantial, but unfortunately migrant individuals with intellectual disability face many challenges, from accessing health services, cultural complexities, financial difficulties, and language barriers, to lack of knowledge on the availability of particular services. Although a common condition, urinary incontinence remains a taboo subject and many individuals do not seek intervention even though it impacts on all aspects of their life. The migrant individual who has an intellectual disability may be unable to understand information that is provided, unable to gain knowledge, access educational material to promote continence and manage incontinence. This article considers what is known on the subject of urinary incontinence for an individual with intellectual disability from the migrant community in Ireland.
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Affiliation(s)
- Anne Marie Kelly
- Clinical Nurse Specialist-Continence, Continence Promotion Services, Dublin 8
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15
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Liu N, Xing L, Mao W, Chen S, Wu J, Xu B, Chen M. Relationship Between Blood Glucose and Hemoglobin A1c Levels and Urinary Incontinence in Women. Int J Gen Med 2021; 14:4105-4116. [PMID: 34366679 PMCID: PMC8336994 DOI: 10.2147/ijgm.s324332] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 07/21/2021] [Indexed: 11/23/2022] Open
Abstract
Objective The purpose of this study was to evaluate the associations between blood glucose and hemoglobin A1c (HbA1c) levels with the degree of stress urinary incontinence (SUI) and urgency urinary incontinence (UUI) in women. Methods We conducted a cross-sectional study of female participants in the National Health and Nutrition Examination Survey (NHANES) database between 2007 and 2012. Univariate and multivariate logistic regressions were used to assess the relationship between blood glucose and HbA1c levels and the degree of SUI and UUI. Results A total of 3821 participants were enrolled in the study, of whom 2421 (63.4%) had no SUI, 1133 (29.7%) had monthly SUI, 267 (7.0%) had weekly SUI; 2883 (75.5%) had no UUI, 735 (19.2%) had monthly UUI, 203 (5.3%) had weekly UUI. The levels of blood glucose and HbA1c were positively correlated with SUI and UUI, and increased with increasing degree of UUI. Multivariate logistic regression showed that there was a positive association between blood HbA1c level and degree of SUI. Conclusion Our study found that blood glucose and HbA1c levels can be used as indicators of SUI and UUI severity in women.
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Affiliation(s)
- Ning Liu
- Department of Urology, Affiliated Zhongda Hospital of Southeast University, Nanjing, 210009, People's Republic of China
| | - Li Xing
- Department of Urology, Affiliated Zhongda Hospital of Southeast University, Nanjing, 210009, People's Republic of China
| | - Weipu Mao
- Department of Urology, Affiliated Zhongda Hospital of Southeast University, Nanjing, 210009, People's Republic of China.,Surgical Research Center, Institute of Urology, Southeast University Medical School, Nanjing, 210009, People's Republic of China.,Department of Urology, Nanjing Lishui District People's Hospital, Zhongda Hospital Lishui Branches, Southeast University, Nanjing, 211200, People's Republic of China
| | - Shuqiu Chen
- Department of Urology, Affiliated Zhongda Hospital of Southeast University, Nanjing, 210009, People's Republic of China
| | - Jianping Wu
- Department of Urology, Affiliated Zhongda Hospital of Southeast University, Nanjing, 210009, People's Republic of China
| | - Bin Xu
- Department of Urology, Affiliated Zhongda Hospital of Southeast University, Nanjing, 210009, People's Republic of China
| | - Ming Chen
- Department of Urology, Affiliated Zhongda Hospital of Southeast University, Nanjing, 210009, People's Republic of China.,Surgical Research Center, Institute of Urology, Southeast University Medical School, Nanjing, 210009, People's Republic of China.,Department of Urology, Nanjing Lishui District People's Hospital, Zhongda Hospital Lishui Branches, Southeast University, Nanjing, 211200, People's Republic of China
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16
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Lane GI, Hagan K, Erekson E, Minassian VA, Grodstein F, Bynum J. Patient-Provider Discussions About Urinary Incontinence Among Older Women. J Gerontol A Biol Sci Med Sci 2021; 76:463-469. [PMID: 32353111 DOI: 10.1093/gerona/glaa107] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Urinary incontinence (UI) is prevalent in women and has been associated with decreased quality of life and institutionalization. Despite this, and the fact that several treatment options exist, few women discuss UI with clinicians. The aim of this study was to examine the proportion of middle aged and older women with urinary incontinence who have discussed UI with clinicians, focusing on female health professionals as a way to examine this question outside of issues of health care access. METHODS Data are from the Nurses Health Studies (NHS), two ongoing observational, prospective, cohort studies. The surveys collected detailed information about UI, including frequency, amount and type. Women were also asked if they had discussed UI with a clinician. We used multivariable-adjusted logistic regression to estimate odds ratios (OR) of participants reporting discussion about UI. RESULTS 94,692 women with UI aged 49-91 years old were included in this study. Of these, 34% reported that they had discussed their incontinence with a clinician. Women with daily UI had 4.4 times greater odds of discussing it with clinicians when compared to those with monthly UI (OR = 4.36, 95% confidence interval [CI] 4.06-4.69). When controlling for severity of symptoms, the oldest women, greater than eighty years, were 20% less likely to have discussed UI with their clinician, compared to the youngest women (OR = 0.81, 95% CI 0.73-0.89). CONCLUSIONS A minority of women with UI, even among health professionals, discuss their symptoms with clinicians. Oldest women were the least likely to discuss their UI with a provider.
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Affiliation(s)
- Giulia I Lane
- Department of Urology, University of Michigan, Ann Arbor.,Institute of Health Policy and Research, University of Michigan, Ann Arbor
| | - Kaitlin Hagan
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.,Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Elisabeth Erekson
- Department of Obstetrics and Gynecology, Maine Medical Center, Portland.,Department of Obstetrics and Gynecology, Tufts University School of Medicine, Boston, Massachusetts
| | - Vatche A Minassian
- Division of Urogynecology, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Francine Grodstein
- Rush Alzheimer's Disease Center, Rush Medical College, Chicago, Illinois
| | - Julie Bynum
- Department of Internal Medicine, University of Michigan, Ann Arbor.,Institute of Health Policy and Research, University of Michigan, Ann Arbor
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17
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Eckhardt SE, Takashima Y, Handler SJ, Tenggardjaja C, Yazdany T. Antibiotic regimen and route of administration do not alter rates of urinary tract infection after intravesical botulinum toxin injection for overactive bladder. Int Urogynecol J 2021; 33:703-709. [PMID: 33594517 DOI: 10.1007/s00192-021-04691-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 01/10/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Guidelines vary on antibiotic prophylaxis for onabotulinumtoxinA (Botox) treatment for overactive bladder (OAB). Our primary objective was to determine whether any prophylactic regimen is more effective in preventing urinary tract infection (UTI) after Botox. The secondary objective was to identify prophylactic practice patterns among female pelvic medicine and reconstructive surgery (FPMRS) providers of different training backgrounds as well as general urologists. METHODS This was a secondary analysis of a retrospective cohort study on urinary retention after Botox injection in women with and without diabetes mellitus and OAB. Women > 18 years old who underwent Botox injection for OAB between January 2013 and September 2018 were included. Exclusion criteria were history of urinary retention and neuromuscular bladder dysfunction. RESULTS A total of 565 patients were included. Two hundred eighty (49.6%) were treated by OB-GYN FPMRS, 209 (37.0%) by urology FPMRS and 76 (13.5%) by general urologists. The majority (92.9%) received antibiotic prophylaxis: 44.4% received intravenous (IV) only, 8.9% received oral (PO) only, and 39.7% received combination IV and PO prophylaxis. Urology FPMRS used antibiotic prophylaxis less frequently (p = 0.003). Within 3 months, 171 patients developed UTI (30.4%). There was no difference in post-procedural UTI for any antibiotic regimen compared to no prophylaxis. No route of antibiotic administration was superior at preventing UTI. CONCLUSIONS In this cohort, no route of antibiotic administration was more effective in the prevention of UTI. Antibiotic prophylaxis did not lower the rate of post-procedural UTI compared to no antibiotics.
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Affiliation(s)
- Sarah E Eckhardt
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Harbor-UCLA Medical Center, 1000 W. Carson Street, Torrance, CA, 90509, USA.
| | - Yoko Takashima
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Harbor-UCLA Medical Center, 1000 W. Carson Street, Torrance, CA, 90509, USA
| | - Stephanie J Handler
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Harbor-UCLA Medical Center, 1000 W. Carson Street, Torrance, CA, 90509, USA
| | - Christopher Tenggardjaja
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Urology, Kaiser Permanente, Los Angeles, CA, USA
| | - Tajnoos Yazdany
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Harbor-UCLA Medical Center, 1000 W. Carson Street, Torrance, CA, 90509, USA
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18
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Biyik I, Usturali Mut AN, Albayrak M, Kucuk B, Koras O, Keskin F, Demirci H. Effect of health literacy on help-seeking behavior: A comparison of patients accepting surgery and refusing surgery for urinary incontinence. J Gynecol Obstet Hum Reprod 2020; 50:101908. [PMID: 32920179 DOI: 10.1016/j.jogoh.2020.101908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 07/22/2020] [Accepted: 09/02/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE(S) To compare the health literacy (HL) of the adult females with SUI complaints in terms of their acceptance or non-acceptance of surgery. METHODS In this cohort study, the European Health Literacy Survey Questionnaire (HLS-EU- Q47) scores as a measure of health literacy were compared among the two groups of patients who accepted to undergo surgery for SUI and the ones who did not. Demographic features, weight and BMI values, comorbidity, menopausal status, duration and type of UI, socioeconomic characteristics (marital status, educational level, level of income) and HLS-EU- Q47 survey results of the two groups were compared. We also investigated the reasons regarding the acceptance or refusal of SUI surgery. RESULTS Among the patients who were offered surgery 474% accepted to undergo operation. Total HLS-EU-Q47 score was 30.04 in the group of patients who accepted surgery and 23.46 in the group who refused surgery. The patients that refused surgery had more often insufficient health literacy level (p=0.001). An excellent health literacy level was higher for patients who agreed to anti-incontinence surgery (p=0.021). CONCLUSIONS Health literacy score of patients with urinary incontinence (UI) who refused surgery was lower than those who accepted surgery. Acceptance of surgery may be increased by providing more understandable and clear information, especially for women with lower HL levels.
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Affiliation(s)
- Ismail Biyik
- Kütahya Health Sciences University, Department of Obstetrics and Gynecology, Kütahya, Turkey.
| | - Ayse Nur Usturali Mut
- Ankara University Medical School, Public Health Department, Division of Epidemiology, Turkey.
| | - Mustafa Albayrak
- Florence Nightingale Hospital, Department of Obstetrics and Gynecology, Istanbul, Turkey.
| | - Bilgen Kucuk
- University of Health Sciences Bursa Yuksek Ihtisas Training and Research Hospital, Department of Family Medicine, Turkey.
| | - Omer Koras
- Mustafakemalpasa State Hospital, Department of Urology, Turkey.
| | - Fatih Keskin
- Mustafakemalpasa State Hospital, Department of Obstetrics and Gynecology, Turkey.
| | - Hakan Demirci
- University of Health Sciences Bursa Yuksek Ihtisas Training and Research Hospital, Department of Family Medicine, Turkey.
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19
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Chung CP, Behrendt C, Wong L, Flores S, Mortimer JE. Serial Assessment of Urinary Incontinence in Breast Cancer Survivors Undergoing (Neo)Adjuvant Therapy. J Natl Compr Canc Netw 2020; 18:712-716. [PMID: 32502980 PMCID: PMC9126173 DOI: 10.6004/jnccn.2020.7535] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 01/10/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Among breast cancer survivors, urinary incontinence (UI) is often attributed to cancer therapy. We prospectively assessed urinary symptoms before and after (neo)adjuvant treatment of early-stage breast cancer. METHODS With consent, women with stage I-III breast cancer completed the Urogenital Distress Inventory and the Incontinence Impact Questionnaire before and 3 months after initiating (neo)adjuvant therapy. Patients with UI were at least slightly bothered by urinary symptoms. If UI was present pretreatment, it was considered prevalent; if UI was new or worse at 3 months posttreatment, it was considered incident; if prevalent UI was no worse at 3 months posttreatment, it was considered stable. Ordinal logistic regression models identified characteristics associated with the level of prevalent UI and with the degree of UI impact on quality of life (QoL). RESULTS On pretreatment surveys, participants (N=203; age 54.5 ± 11.4 years) reported 79.8% prevalence of UI, including overactive bladder (29.1%), stress incontinence (10.8%), or both (39.9%). The level of prevalent UI increased with body mass index (BMI; P<.05). Of 163 participants assessed at both time points, incident UI developed in 12 of 32 patients without prevalent UI and 27 of 131 patients with prevalent UI. Regardless of whether UI was prevalent (n=162), incident (n=39), or stable (n=94) at QoL assessment, the impact of UI increased (P<.01) with the number and severity of UI symptoms, subjective urinary retention, and BMI. Adjusted for those characteristics, incident UI had less impact on QoL (P<.05) than did prevalent or stable UI. CONCLUSIONS We found that UI is highly prevalent at breast cancer diagnosis and that new or worsened UI is common after (neo)adjuvant therapy. Because UI often impairs QoL, appropriate treatment strategies are needed.
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Affiliation(s)
- Christopher P. Chung
- Urogynecology, Division of Gynecologic Oncology, City of Hope National Medical Center, Duarte, California
| | - Carolyn Behrendt
- Division of Biostatistics, Department of Computational and Quantitative Medicine, City of Hope National Medical Center, Duarte, California
| | - Louise Wong
- Department of Medical Oncology, City of Hope National Medical Center, Duarte, California
| | - Sarah Flores
- Department of Medical Oncology, City of Hope National Medical Center, Duarte, California
| | - Joanne E. Mortimer
- Department of Medical Oncology, City of Hope National Medical Center, Duarte, California
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20
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von Kodolitsch Y, Demolder A, Girdauskas E, Kaemmerer H, Kornhuber K, Muino Mosquera L, Morris S, Neptune E, Pyeritz R, Rand-Hendriksen S, Rahman A, Riise N, Robert L, Staufenbiel I, Szöcs K, Vanem TT, Linke SJ, Vogler M, Yetman A, De Backer J. Features of Marfan syndrome not listed in the Ghent nosology – the dark side of the disease. Expert Rev Cardiovasc Ther 2020; 17:883-915. [DOI: 10.1080/14779072.2019.1704625] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Yskert von Kodolitsch
- German Aorta Center Hamburg at University Hospital Hamburg Eppendorf University Heart Centre, Clinics for Cardiology and Heart Surgery, VASCERN HTAD European Reference Centre
| | - Anthony Demolder
- Center for Medical Genetics and Department of Cardiology, Ghent University Hospital, VASCERN HTAD European Reference Centre, Ghent, Belgium
| | - Evaldas Girdauskas
- German Aorta Center Hamburg at University Hospital Hamburg Eppendorf University Heart Centre, Clinics for Cardiology and Heart Surgery, VASCERN HTAD European Reference Centre
| | - Harald Kaemmerer
- Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Centre Munich of the Free State of Bavaria, Munich
| | - Katharina Kornhuber
- Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Centre Munich of the Free State of Bavaria, Munich
| | - Laura Muino Mosquera
- Department of Pediatric Cardiology and Center for Medical Genetics, Ghent University Hospital, Ghent, Belgium
| | - Shaine Morris
- Department of Pediatrics-Cardiology, Texas Children’s Hospital/Baylor College of Medicine, Houston, TX, USA
| | - Enid Neptune
- Division of Pulmonary and Critical Care Medicine and Institute of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Reed Pyeritz
- Departments of Medicine and Genetics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Svend Rand-Hendriksen
- TRS, National Resource Centre for Rare Disorders, Sunnaas Rehabilitation Hospital, Nesoddtangen, Norway
| | - Alexander Rahman
- Department of Conservative Dentistry, Periodontology and Preventive Dentistry, Hannover Medical School, Hannover
| | - Nina Riise
- TRS, National Resource Centre for Rare Disorders, Sunnaas Rehabilitation Hospital, Nesoddtangen, Norway
| | - Leema Robert
- Department of Clinical Genetics, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Ingmar Staufenbiel
- Department of Conservative Dentistry, Periodontology and Preventive Dentistry, Hannover Medical School, Hannover
| | - Katalin Szöcs
- German Aorta Center Hamburg at University Hospital Hamburg Eppendorf University Heart Centre, Clinics for Cardiology and Heart Surgery, VASCERN HTAD European Reference Centre
| | - Thy Thy Vanem
- TRS, National Resource Centre for Rare Disorders, Sunnaas Rehabilitation Hospital, Nesoddtangen, Norway
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
| | - Stephan J. Linke
- Clinic of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Ophthalmological practice at the University Clinic Hamburg-Eppendorf, zentrumsehstärke, Hamburg, Germany
| | - Marina Vogler
- German Marfan Association, Marfan Hilfe Deutschland e.V, Eutin, Germany
| | - Anji Yetman
- Vascular Medicine, Children’s Hospital and Medical Center, Omaha, USA
| | - Julie De Backer
- Center for Medical Genetics and Department of Cardiology, Ghent University Hospital, VASCERN HTAD European Reference Centre, Ghent, Belgium
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21
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Levy G, Lowenstein L. Overactive Bladder Syndrome Treatments and Their Effect on Female Sexual Function: A Review. Sex Med 2019; 8:1-7. [PMID: 31604683 PMCID: PMC7042164 DOI: 10.1016/j.esxm.2019.08.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 08/06/2019] [Accepted: 08/12/2019] [Indexed: 01/23/2023] Open
Abstract
Introduction Overactive bladder (OAB), the most common subtype of urinary incontinence, has a heavy price on quality of life, especially on sexual life. Unfortunately, most women rarely voice the worsening of sexual function, especially those who already suffer from OAB symptoms. It has been demonstrated that patients who suffer from OAB score lower on Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire and Female Sexual Function Index scores, meaning that their sexual function is debilitated. Therapies for OAB begin with traditional pelvic floor physiotherapy, advance to anticholinergic drugs, and become more invasive with intravesical injections of onabotulinumtoxinA (commonly known as Botox). Last, for patients resistant to conservative therapies, sacral neuromodulation is the treatment of choice. Methods This article reviews the current literature that sheds light on the above 4 treatments and their effect on sexual function. This topic is of great importance because of the under-reporting of sexual dysfunction in women who suffer from OAB, in hopes of raising awareness of sexual function for clinicians treating patients with OAB. Results This review found that the aforementioned 4 treatments for OAB (physiotherapy, anticholinergic drugs, intravesical injections of onabotulinumtoxinA, and sacral neuromodulation) do not have a detrimental affect on sexual function. On the contrary, the little data that do exist show that sexual function increases after these therapies are completed in women with OAB. Conclusion This review concludes with a positive outlook: physicians are helping women with OAB syndrome to improve their sexual function. However, not enough data exist, partially due to under-reporting of diminished sexual function. Levy G, Lowenstein L. Overactive Bladder Syndrome Treatments and Their Effect on Female Sexual Function: A Review. Sex Med 2019;8:1–7.
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Affiliation(s)
- Gali Levy
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel; Tel Aviv, Israel.
| | - Lior Lowenstein
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel
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22
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Fernández-Cuadros M, Albaladejo-Florín M, Álava-Rabasa S, Pérez-Moro O. [Effectiveness of 6 manometric biofeedback sessions on urinary incontinence and quality of life: A before-after study of 67 patients]. Rehabilitacion (Madr) 2019; 53:146-154. [PMID: 31370941 DOI: 10.1016/j.rh.2019.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 04/15/2019] [Accepted: 04/18/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To determine whether a short 6-session protocol of tonic/ phasic exercises can enhance quality of life and muscular strength in patients with urinary incontinence (UI). MATERIAL AND METHODS A prospective before-after study was performed in 67 patients with UI referred to the Rehabilitation Department of the Santa Cristina University Hospital in Madrid, Spain. In the initial assessment, the patient's personal details, predisposing factors and type of UI were registered. Patients received lifestyle recommendations. The ICIQ-SF/I-QOL questionnaires/scales were completed at the beginning and end of treatment. The manometric evaluation was registered in the first and last assessment by the MYOMED® 932 equipment. The protocol consisted of a 30-minute session of tonic/phasic exercises (15minutes each) twice weekly for a maximum of 6 sessions, supervised by a physiotherapist. RESULTS The mean age was 52.1±12.7 years and 94% of the patients (n=63) were women. The maximum and mean strength of the pelvic floor contraction was 26.4±15.6 and 5.3±3.9mmHg, respectively, which significantly increased after treatment to 35.5±19.6 and 7.6±4.4mmHg (P<.0001). The ICIQ-SF score was 10.1±5 and significantly decreased to 6.6±4.6 (P<0.0001). The I-QOL score significantly increased from 66.1±21.9 to 77.9±18.1 points (P<.0001). The I-QOL ALB subscale (avoidance and limiting behaviour) increased from 63.7±22.6 to 77.3±17.8 (P<.0001); the I-QoL PSI subscale (psychosocial impact) increased from 73.8±23.9 to 82.5±18.7 (P=.0004); and the I-QOL SE subscale (social embarrassment) increased from 56.5±23.7 to 70.5±22.1 (P<.0001). CONCLUSION Manometric feedback reduces UI and improves both quality of life and manometric values. This short 6-session protocol could be applied in other public and private centres and could provide economic benefits to the health system and to patients.
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Affiliation(s)
- M Fernández-Cuadros
- Servicio de Rehabilitación y Medicina Física, Fundación Hospital General de la Santísima Trinidad, Salamanca, España; Servicio de Rehabilitación y Medicina Física, Hospital Universitario Santa Cristina, Madrid, España.
| | - M Albaladejo-Florín
- Servicio de Rehabilitación y Medicina Física, Hospital Universitario Santa Cristina, Madrid, España
| | - S Álava-Rabasa
- Servicio de Rehabilitación y Medicina Física, Hospital Universitario Santa Cristina, Madrid, España
| | - O Pérez-Moro
- Servicio de Rehabilitación y Medicina Física, Hospital Universitario Santa Cristina, Madrid, España
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Abstract
PURPOSE The aims of this investigation were to examine how often outpatient visits addressing urinary incontinence in women with self-reported incontinence symptoms occur and to explore characteristics associated with an outpatient visit for incontinence. MATERIALS AND METHODS We studied the records of 18,576 women from the Nurses' Health Study who were 65 years old or older, reported prevalent incontinence symptoms in 2012 on a mailed questionnaire and were linked with Medicare utilization data. We compared demographic, personal and clinical characteristics in women with and without claims for outpatient visits for urinary incontinence. In logistic regression models we controlled for potential confounding factors, including age, race, parity, body mass index, medical comorbidities, smoking status, health seeking behavior, disability, physical function and geographic region. RESULTS In this linkage between symptom report and insurance claims data we found that only 16% of older women with current incontinence symptoms also had an outpatient visit addressing incontinence in the prior 2 years. In multivariable adjusted models severe vs slight incontinence (OR 3.75, 95% CI 3.10-4.53) and urgency vs stress incontinence (OR 1.80, 95% CI 1.56-2.08) were the strongest predictors of undergoing outpatient evaluation. CONCLUSIONS Overall only a small percent of women who report urinary incontinence symptoms also have medical outpatient visits for incontinence, which is a marker of care seeking. Our study highlights the discordance between the high prevalence of incontinence in older women and the lack of clinical assessment despite symptoms even among nurses with high health care literacy.
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Fusco HCSDC, Pontes Filho MAG, Haddad JM, Zanetti MRD, Marques AP, Ferreira EAG. Lower urinary tract symptoms and perineal function in women with and without fibromyalgia: a cross-sectional study. Clin Rheumatol 2019; 38:2885-2890. [PMID: 31152258 DOI: 10.1007/s10067-019-04617-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 02/09/2019] [Accepted: 05/19/2019] [Indexed: 02/07/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Fibromyalgia (FM) studies have focused on pain, but a 2010 review of the diagnostic criteria pointed to other symptoms including urinary incontinence (UI). Women with FM present pain, fatigue, and reduced muscle strength; the research hypothesis was that pelvic floor (PF) muscles would be weaker; therefore, FM could be associated with lower urinary tract symptoms (LUTS) and compromise quality of life (QoL). The aim of this paper was to compare PF function, urinary symptoms, and their impact on QoL in women with and without FM and to verify if there is association between FM and LUTS. METHODS We performed a cross-sectional study with 126 sexually active women aged between 19 and 65 years old, distributed in two groups, women with FM (FG n = 62) and without FM (NFG n = 64). Perineal function was the primary outcome and was assessed by perineometry and bidigital vaginal palpation (PERFECT Scheme). Presence of LUTS was assessed by interview based on international definition, and the impact of UI on QoL was evaluated by the King's Health Questionnaire (KHQ). RESULTS FG presented worse PF function on clinical exam (p < 0.001) and perineometry (p = 0.04). LUTS was more frequent among FG (p < 0.001). In terms of QoL, FG obtained lower KHQ scores for general health perception (p < 0.001) and sleep/energy (p < 0.003) domains. The odds of presenting LUTS is 5.03 (95%CI 2.35-10.75) higher in women with FM. CONCLUSION Women with FM had worse perineal function, had more LUTS, and presented UI more frequently, which negatively impacts on QoL.
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Affiliation(s)
- Hellen Cristina Souza de Carvalho Fusco
- Department of Physiotherapy, Speech Therapy and Occupational Therapy, Faculty of Medicine, University of São Paulo, Rua Cipotânea, 51, Cidade Universitária, São Paulo, Brazil.
| | | | - Jorge Milhem Haddad
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | | | - Amélia Pasqual Marques
- Department of Physiotherapy, Speech Therapy and Occupational Therapy, Faculty of Medicine, University of São Paulo, Rua Cipotânea, 51, Cidade Universitária, São Paulo, Brazil
| | - Elizabeth Alves Gonçalves Ferreira
- Department of Physiotherapy, Speech Therapy and Occupational Therapy, Faculty of Medicine, University of São Paulo, Rua Cipotânea, 51, Cidade Universitária, São Paulo, Brazil
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Biyik I, Kucuk B, Arpaci HF, Demirci H. Factors affecting doctor visits of postmenopausal women with urinary incontinence. Low Urin Tract Symptoms 2019; 11:200-205. [PMID: 30916894 DOI: 10.1111/luts.12261] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 01/29/2019] [Accepted: 02/25/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study analyzed the reasons for avoiding visiting a doctor among women aged ≥50 years with urinary incontinence (UI), as well as factors influencing visits to the doctor. METHODS In all, 402 women aged ≥50 years who were enrolled in Bursa healthcare centers, 150 with UI and 252 without UI, participated in the study. This study was conducted between January 2018 and August 2018. Participants were asked to complete the International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF) questionnaire. Quality of life was evaluated using the Incontinence Impact Questionnaire, Short Form (IIQ-7) questionnaire. RESULTS The prevalence of UI was 37%. Of the women with UI, 52 (34.67%) visited a doctor for complaints. The most frequent reason for seeing a doctor because of UI was that it had started to affect activities of daily living. The most frequent reason for avoiding visiting a doctor was the belief that UI was normal. Scores on the ICIQ-SF were higher among women who visited a doctor. Physical activity, social relationships, and mental health scores on the IIQ-7 were also higher among patients who visited a doctor. CONCLUSIONS Patients who suffer from severe UI and whose quality of life is affected more negatively are more likely to visit a doctor. Women who believe that UI is normal are less likely to visit a doctor. Awareness about UI should be increased in order to increase the rate of visiting a doctor for this condition.
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Affiliation(s)
- Ismail Biyik
- Department of Obstetrics and Gynecology, Karacabey State Hospital, Bursa, Turkey
| | - Bilgen Kucuk
- Department of Family Medicine, University of Health Sciences Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Husniye F Arpaci
- Department of Family Medicine, University of Health Sciences Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Hakan Demirci
- Department of Family Medicine, University of Health Sciences Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
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Sleep Quality and Daytime Sleepiness Among Women With Urgency Predominant Urinary Incontinence. Female Pelvic Med Reconstr Surg 2019; 24:76-81. [PMID: 29300259 DOI: 10.1097/spv.0000000000000547] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The objective of this study was to examine the strength and direction of the association between urinary symptoms and both poor quality sleep and daytime sleepiness among women with urgency urinary incontinence. METHODS A planned secondary analysis of baseline characteristics of participants in a multicenter, double-blinded, 12-week randomized controlled trial of pharmacologic therapy for urgency-predominant urinary incontinence in ambulatory women self-diagnosed by the 3 Incontinence Questions was performed. Urinary symptoms were assessed by 3-day voiding diaries. Quality of sleep was assessed using the Pittsburgh Sleep Quality Index (PSQI) and daytime sleepiness using the Epworth Sleepiness Scale. RESULTS Of the 640 participants, mean (SD) age was 56 (±14) years and 68% were white. Participants reported an average of 3.9 (±3.0) urgency incontinence episodes per day and 1.3 (±1.3) episodes of nocturia per night. At baseline, 57% had poor sleep quality (PSQI score, >5) and 17% reported daytime sleepiness (Epworth Sleepiness Scale score, >10). Most women (69%) did not use sleeping medication during the prior month, whereas 13% reported use of sleeping medication 3 or more times per week. An increase in total daily incontinence episodes, total daily urgency incontinence episodes, total daily micturitions, and moderate to severe urge sensations were all associated with higher self-report of poor sleep quality according to the PSQI (all P ≤ 0.01). Higher scores on the Bother Scale and the Health-Related Quality of Life for overactive bladder on the Overactive Bladder Questionnaire were similarly associated with higher rates of poor sleep quality (both P ≤ 0.01). In subgroup analysis of those who took sleeping medications less than twice a week, there was still a significant relationship between incontinence measures and quality of sleep as measured by the PSQI. In multivariable analyses, greater frequency of nighttime urgency incontinence was associated with poor sleep quality (P = 0.03). CONCLUSIONS Among ambulatory women with urgency urinary incontinence, poor sleep quality is common and greater frequency of incontinence is associated with a greater degree of sleep dysfunction. Women seeking urgency urinary incontinence treatment should be queried about their sleeping habits so that they can be offered appropriate interventions.
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Yang E, Lisha NE, Walter L, Obedin-Maliver J, Huang AJ. Urinary Incontinence in a National Cohort of Older Women: Implications for Caregiving and Care Dependence. J Womens Health (Larchmt) 2018; 27:1097-1103. [PMID: 29902123 DOI: 10.1089/jwh.2017.6891] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Urinary incontinence (UI) can interfere with older women's ability to perform activities of daily living (ADLs), but little is known about factors that predispose incontinent women to become functionally dependent or compromise their ability to serve as caregivers to others. STUDY DESIGN UI, caregiving, and care-receiving behaviors were assessed by questionnaire in a national sample of community-dwelling older women. Multivariable models evaluated associations between incontinence and care dependence, assessed factors associated with care dependence among incontinent women, and compared health among female caregivers with and without incontinence. RESULTS Of the 1703 women, 27% reported weekly or more incontinence and 13% monthly incontinence. Women with weekly or more incontinence were more likely than women without incontinence to report receiving care for ADLs (AOR = 2.39, CI = 1.61-3.56) or instrumental ADLs (AOR = 1.94, CI = 1.42-2.63). Compared to 46% of women without incontinence, 60% of women with monthly or weekly incontinence reported unmet care needs (p = 0.0002). Factors associated with care dependence included more frequent incontinence, older age, marital status, and fair/poor health (p < 0.05 for all). Overall, 15% of women served as a caregiver for another adult, which did not differ by incontinence status (p = 0.84), but female caregivers with incontinence reported worse health than those without incontinence (p = 0.0004). CONCLUSIONS In this national cohort, older women with incontinence were more likely to be functionally dependent and have unmet care needs than those without incontinence, after adjustment for other factors. At least one in ten incontinent women served as caregivers, despite having worse health than female caregivers without incontinence.
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Affiliation(s)
- Emmy Yang
- 1 Icahn School of Medicine at Mount Sinai , New York, New York
| | - Nadra E Lisha
- 2 Department of Medicine, University of California San Francisco , San Francisco, California
| | - Louise Walter
- 2 Department of Medicine, University of California San Francisco , San Francisco, California.,3 Division of Geriatrics, Veterans Affairs Medical Center , San Francisco, California
| | - Juno Obedin-Maliver
- 4 Department of Obstetrics, Gynecology, & Reproductive Sciences, University of California San Francisco , San Francisco, California.,5 Division of Gynecology, Veterans Affairs Medical Center , San Francisco, California
| | - Alison J Huang
- 2 Department of Medicine, University of California San Francisco , San Francisco, California
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Development and Validation of a Quantitative Measure of Adaptive Behaviors in Women With Pelvic Floor Disorders. Female Pelvic Med Reconstr Surg 2018. [PMID: 28650896 DOI: 10.1097/spv.0000000000000431] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE To establish validity for the Pelvic Floor Disorders Network (PFDN) self-administered Adaptive Behavior Index (ABI) and to assess whether ABI assesses known discordance between severity of pelvic floor symptoms and self-reported bother. METHODS In addition to the ABI questionnaire, participants in 1 of 6 Pelvic Floor Disorders Network trials completed condition-specific measures of pretreatment symptom severity (including Pelvic Floor Distress Inventory; PFDI) and health-related quality of life (Pelvic Floor Impact Questionnaire; PFIQ). The final survey was developed from an iterative process using subject and expert endorsement, factor analyses, and response distributions. Domains were created using a development cohort (n = 304 women), reliability and validity were established using a validation cohort (n = 596 women), and test-retest reliability was assessed (n = 111 women). RESULTS Factor analyses supported an 11-item avoidance domain and a 6-item hygiene domain. Cronbach' alphas were 0.88 and 0.68, respectively. Test-retest reliability was 0.84 for both domains. Construct validity was demonstrated in correlations between the ABI domains and baseline PFDI and PFIQ (r values, 0.43-0.79 with all P values <0.0001). Moreover, the ABI accounted for 8% to 26% of unexplained variance between the symptoms severity measure and the impact on health related quality of life. After treatment, avoidance domain scores improved for urinary and fecal incontinence groups and hygiene scores improved for the fecal incontinence group. CONCLUSIONS The ABI is a reliable and valid measure in women with pelvic floor disorders. Adaptive behaviors account in part for discordance between pelvic floor symptom severity and bother.
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Trends in Ambulatory Management of Urinary Incontinence in Women in the United States. Female Pelvic Med Reconstr Surg 2018; 23:250-255. [PMID: 28106650 DOI: 10.1097/spv.0000000000000365] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVES Urinary incontinence (UI) is a common condition, but despite the availability of guidelines, variations exist in the care of patients. We sought to assess the changes in assessment and management of women with UI over time in the United States. METHODS The National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey are annual surveys from a nationally representative sample of visits to physicians. From 1999 through 2010, we identified visits by women to physicians where the chief complaint was UI using reason-for-visit and International Classification of Diseases, Ninth Revision codes. RESULTS Using 2-year intervals between 1999-2000 and 2009-2010, the number of visits by women with UI to physicians increased (5.3 million to 6.8 million). There was no difference in patient age, race/ethnicity, or physician specialty (primary care, urology, gynecology). The majority did not have their incontinence characterized (42.4%-47.4%). The use of urinalysis significantly decreased (53%-37.2%, P = 0.02), whereas antimuscarinic use significantly increased (16.7%-35%, P = 0.006). There was an overall increased trend in number of referrals to another physician (5.8%-14.7%, P = 0.06). Urologists had a significant increase in antimuscarinic use (23.5%-44.2%, P = 0.003). All physician specialties demonstrated a decreased trend in use of urinalysis between 1999 and 2010. Although imaging rates were low, they were at highest rates among urologists. CONCLUSIONS The majority of women do not have the type of UI characterized, whereas there is underutilization of urinalysis. Given the widespread prevalence of UI and its implications on quality of life, greater adherence to guidelines is warranted.
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Al-Shaikh G, Syed S, Osman S, Bogis A, Al-Badr A. Pessary use in stress urinary incontinence: a review of advantages, complications, patient satisfaction, and quality of life. Int J Womens Health 2018; 10:195-201. [PMID: 29713205 PMCID: PMC5909791 DOI: 10.2147/ijwh.s152616] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Stress urinary incontinnce (SUI) is a common condition among women. The usual approach to treatment of SUI is a stepwise plan from conservative to surgical procedures. A vaginal pessary is one of the commonly used conservative treatments that offer symptomatic improvement for women with incontinence. This review provides a critical analysis of the benefits and shortcomings offered by vaginal pessaries to patients affected by SUI, with a particular focus on indications, advantages, quality of life, patient satisfaction, and potential complications. To obtain the required information, an extensive search of PubMed and Cochrane databases was performed, covering the time frame from January 2000 to December 2016. We also surveyed the published guidelines of American Urological Association, Canadian Urological Association, American Urogynecological Society, National Institutes of Health (USA), and National Institute for Health and Care Excellence (UK). A total of 192 original research papers, review articles, and clinical trials were identified. The analysis of retrieved data provides evidence that vaginal pessaries constitute an effective nonsurgical option for SUI. The satisfaction rate with pessary use is high and only minor complications, if any, occur, vaginal discharge being the most common. The reviewed studies document that vaginal pessaries provide an adequate control of SUI if they are fit properly and managed by frequent replacements and regular checkups. They should be considered among the first line of treatment for SUI associated with exercise and increased intra-abdominal pressure.
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Affiliation(s)
- Ghadeer Al-Shaikh
- Department of Obstetrics and Gynecology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Sadiqa Syed
- Department of Basic Sciences, College of Medicine, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Somaia Osman
- Department of Urogynecology & Pelvic Reconstructive Surgery, Women's Specialized Hospital, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Abdulrahman Bogis
- Department of Obstetrics and Gynecology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ahmed Al-Badr
- Department of Urogynecology & Pelvic Reconstructive Surgery, Women's Specialized Hospital, King Fahad Medical City, Riyadh, Saudi Arabia
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Tadrous M, Elterman D, Khuu W, Mamdani MM, Juurlink DN, Gomes T. Publicly funded overactive bladder drug treatment patterns in Ontario over 15 years: An ecological study. Can Urol Assoc J 2018; 12:E142-E145. [PMID: 29319477 DOI: 10.5489/cuaj.4541] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Medication is an important option for patients with overactive bladder (OAB), with four different drugs approved over the last 10 years, including the first non-anticholinergic treatment, mirabegron. We set out to describe the number and rate of users of medication for the management of OAB over the last 15 years among residents of Ontario, Canada covered by the public drug programs. METHODS We conducted a population-based, repeated cross-sectional study examining quarterly publically funded prescription claims for OAB medications from January 2000 to June 2016 in Ontario, Canada. RESULTS We report two major changes in prescription patterns for OAB. The first was the rise of newer, more selective anticholinergics (tolterodine, solifenacin, and darifenacin) replacing oxybutynin. This led to a 54.8% reduction in the rate of users of oxybutynin over the study period from 10.4 users/1000 beneficiaries in 2000 to 4.7 users/1000 beneficiaries in 2016. Recently, we saw the emergence of mirabegron as the most commonly prescribed treatment for OAB. By the final quarter of the observation period, mirabegron was the most commonly used OAB treatment with 25.0% (n=19 411) of all OAB medication users in Ontario (n=77 660). CONCLUSIONS Our findings highlight the rapid uptake of novel agents and a major shift in the treatment of OAB over the last three years.
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Affiliation(s)
- Mina Tadrous
- Li Ka Shing Knowledge Institute, St. Michael's Hospital; Toronto, ON, Canada.,Institute for Clinical Evaluative Sciences; Toronto, ON, Canada.,Leslie Dan Faculty of Pharmacy, University of Toronto; Toronto, ON, Canada
| | - Dean Elterman
- Division of Urology, Department of Surgery, University Health Network; Toronto, ON, Canada.,Department of Surgery, University of Toronto; Toronto, ON, Canada
| | - Wayne Khuu
- Institute for Clinical Evaluative Sciences; Toronto, ON, Canada
| | - Muhammad M Mamdani
- Li Ka Shing Knowledge Institute, St. Michael's Hospital; Toronto, ON, Canada.,Institute for Clinical Evaluative Sciences; Toronto, ON, Canada.,Leslie Dan Faculty of Pharmacy, University of Toronto; Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto; Toronto, ON, Canada
| | - David N Juurlink
- Institute for Clinical Evaluative Sciences; Toronto, ON, Canada.,Sunnybrook Research Institute; Toronto, ON, Canada
| | - Tara Gomes
- Li Ka Shing Knowledge Institute, St. Michael's Hospital; Toronto, ON, Canada.,Institute for Clinical Evaluative Sciences; Toronto, ON, Canada.,Leslie Dan Faculty of Pharmacy, University of Toronto; Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto; Toronto, ON, Canada
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Dağdeviren H, Cengiz H, Helvacıoğlu Ç, Heydarova U, Kaya C, Ekin M. A comparison of normal and high post-void residual urine and urodynamic parameters in women with overactive bladder. Turk J Obstet Gynecol 2017; 14:210-213. [PMID: 29379662 PMCID: PMC5780563 DOI: 10.4274/tjod.84666] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 10/18/2017] [Indexed: 12/01/2022] Open
Abstract
Objective To investigate voiding functions and assess the relationships of voiding parameters to overactive bladder symptoms and postvoiding residue volumes. Materials and Methods This is a retrospective study analyzing urodynamic parameters in patients who were diagnosed as having overactive in our urogynecology clinic between April 2014 and April 2016. A total of 290 women who met the selection criteria were included in the study. The patients were divided into two groups according to postvoiding residue volumes: group 1, postvoiding residue volumes <100 mL (n=135); group 2, postvoiding residue volumes ≥100 mL (n=155). Results A total of 290 women were included in the study; the mean age was 71.4 years. A total of 158 (54.5%) patients had detrusor over-activity during urodynamic testing. The mean maximum bladder capacity in elevated group 2 (postvoiding residue volumes ≥100 mL) was significantly higher than in group 1 (postvoiding residue volumes <100 mL) (p<0.01). Additionally, there was a significant difference between detrusor pressure at Qmax in both study groups (p<0.05). There were no significant differences in the first-sensation volume between the normal and elevated postvoiding residue volumes groups. Conclusion In conclusion, patients with overactive with elevated postvoiding residue volumes showed increased maximum bladder capacity, but detrusor over-activity was not more prevalent in these women compared with women with normal postvoiding residue volumes.
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Affiliation(s)
- Hediye Dağdeviren
- University of Health Sciences, Bakırköy Dr. Sadi Konuk Training and Research Hospital, Clinic of Obstetric and Gynecology, İstanbul, Turkey
| | - Hüseyin Cengiz
- University of Health Sciences, Bakırköy Dr. Sadi Konuk Training and Research Hospital, Clinic of Obstetric and Gynecology, İstanbul, Turkey
| | - Çağlar Helvacıoğlu
- University of Health Sciences, Bakırköy Dr. Sadi Konuk Training and Research Hospital, Clinic of Obstetric and Gynecology, İstanbul, Turkey
| | - Ulkar Heydarova
- University of Health Sciences, Bakırköy Dr. Sadi Konuk Training and Research Hospital, Clinic of Obstetric and Gynecology, İstanbul, Turkey
| | - Cihan Kaya
- University of Health Sciences, Bakırköy Dr. Sadi Konuk Training and Research Hospital, Clinic of Obstetric and Gynecology, İstanbul, Turkey
| | - Murat Ekin
- University of Health Sciences, Bakırköy Dr. Sadi Konuk Training and Research Hospital, Clinic of Obstetric and Gynecology, İstanbul, Turkey
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Shaw JM, Johnson DD, Nygaard IE. Engaging Undergraduate Kinesiology Students in Clinically-Based Research. QUEST (GRAND RAPIDS, MICH.) 2017; 70:292-303. [PMID: 30220836 PMCID: PMC6133246 DOI: 10.1080/00336297.2017.1380054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Many undergraduate students in kinesiology are interested in clinical careers and seek research opportunities for advanced study and unique learning experiences. This paper describes a process of engaging undergraduate students in a multi-disciplinary, NIH-funded Program Project investigating factors that may affect pelvic floor support and symptoms in primiparous women during the first year postpartum. Students complete general and protocol-specific training prior to engagement, have specific tasks that reinforce skill development and require independence, and are invited to participate in additional opportunities with the investigative team. The topic of pelvic floor health is novel to most students and participation in this research expands their knowledge beyond a mainstream kinesiology curriculum. Institutionalizing this type of program could formalize undergraduate student research experiences and facilitate ongoing clinical research efforts with a kinesiology focus.
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Chai TC, Asfaw TS, Baker JE, Clarkson B, Coleman P, Hoffstetter S, Konkel K, Lavender M, Nair S, Norton J, Subak L, Visco A, Star RA, Bavendam T. Future Directions of Research and Care for Urinary Incontinence: Findings from the National Institute of Diabetes and Digestive and Kidney Diseases Summit on Urinary Incontinence Clinical Research in Women. J Urol 2017; 198:22-29. [PMID: 28286067 DOI: 10.1016/j.juro.2016.10.133] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE Female urinary incontinence is prevalent, costly and morbid. Participants in a NIDDK (National Institute of Diabetes and Digestive and Kidney Diseases) sponsored summit reviewed findings from NIH (National Institutes of Health) funded clinical research on urinary incontinence in women and discussed the future of urinary incontinence research. MATERIALS AND METHODS The NIDDK convened the Summit on Urinary Incontinence Clinical Research in Women on March 14, 2014. Participants representing a broad range of clinical expertise reviewed completed NIH sponsored urinary incontinence related studies, including results from community based epidemiological studies such as the BACH (Boston Area Community Health) Survey and from randomized clinical trials such as PRIDE (Program to Reduce Incontinence by Diet and Exercise), and studies conducted by the Pelvic Floor Disorders Network and the Urinary Incontinence Treatment Network. RESULTS BACH Survey results improved our understanding of precursors, incidence, prevalence and natural history of urinary incontinence in a diverse group of women. The Pelvic Floor Disorders Network study found that anticholinergic medications and onabotulinumtoxinA are efficacious for treating urge urinary incontinence, and Burch colposuspension and retropubic mid urethral polypropylene slings are efficacious for decreasing stress urinary incontinence following pelvic organ prolapse surgery in women with potential stress urinary incontinence. The Urinary Incontinence Treatment Network study found that fascial slings were better than colposuspension, and that retropubic and transobturator mid urethral polypropylene slings were equivalent for stress urinary incontinence. In patients with stress urinary incontinence a preoperative urodynamic study was noninferior to basic office examinations for surgical outcome. The addition of behavioral intervention did not allow female patients to discontinue antimuscarinics for urge urinary incontinence. PRIDE showed that modest weight reductions significantly decreased urinary incontinence. CONCLUSIONS Strategies for future research on urinary incontinence should include a focus on early disease, risk factor identification, better phenotyping, incorporation of new technologies, patient centered research and prevention.
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Affiliation(s)
- Toby C Chai
- Department of Urology, Yale School of Medicine, New Haven, Connecticut.
| | - Tirsit S Asfaw
- Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, New York
| | - Jan E Baker
- Department of Obstetrics and Gynecology, University of Utah Health Care, Salt Lake City, Utah
| | - Becky Clarkson
- Division of Geriatric Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Susan Hoffstetter
- Department of Obstetrics, Gynecology and Women's Health, St. Louis University School of Medicine, St. Louis, Missouri
| | - Kimberly Konkel
- Center for Faith-Based and Neighborhood Partnerships, U.S. Department of Health and Human Services, Washington, D.C
| | | | - Shailaja Nair
- Drexel Center for Women's Health, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Jenna Norton
- Division of Kidney, Urologic and Hematologic Disease, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland
| | - Leslee Subak
- Department of Obstetrics, Gynecology and Reproductive Science, University of California, San Francisco, San Francisco, California
| | - Anthony Visco
- Division of Urogynecology, Duke University School of Medicine, Durham, North Carolina
| | - Robert A Star
- Division of Kidney, Urologic and Hematologic Disease, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland
| | - Tamara Bavendam
- Division of Kidney, Urologic and Hematologic Disease, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland
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Multimodal vaginal toning for bladder symptoms and quality of life in stress urinary incontinence. Int Urogynecol J 2016; 28:1201-1207. [PMID: 28035444 PMCID: PMC5514206 DOI: 10.1007/s00192-016-3248-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Accepted: 12/12/2016] [Indexed: 11/26/2022]
Abstract
Introduction and hypothesis Treatment options for women with stress urinary incontinence (SUI) have limitations. We hypothesized that multimodal vaginal toning therapy would improve bladder symptoms and quality of life in women with postpartum SUI and sexual function complaints. Methods Patients self-administered 24 sessions of multimodal vaginal toning therapy lasting 10 min each over 50 days. Outcomes included 1-h pad weight test, Urogenital Distress Inventory Short Form (UDI-6), Incontinence Impact Questionnaire-Short Form (IIQ-7), Female Sexual Distress Scale-Revised 2005 (FSDS-R), Female Sexual Function Index (FSFI), pelvic floor muscle strength, patient satisfaction, and adverse events. Results Of the 55 patients enrolled (safety population), 48 completed the study per-protocol (PP population). A total of 38 (79%) patients had a positive 1-h pad weight test at baseline. In this group, urine leakage was moderate or severe in 82% of patients at baseline, but in only 18% after treatment. Treatment success was 84%, defined as >50% improvement in pad weight relative to baseline. In the PP population, mean UDI-6 score improved by 50% (p < 0.001) and IIQ-7 score improved by 69% (p < 0.001). Sexual function quality of life improved by 54% for FSDS-R and 15% for FSFI (both p < 0.001). Pelvic floor muscle strength significantly improved (p < 0.001). Patient satisfaction with therapy was reported in 83% of patients. In the safety population, 2 (3.6%) adverse events were reported—1 urinary tract infection and 1 report of discomfort due to excessive warmth. Conclusions Multimodal vaginal toning therapy yields clinically meaningful improvements in bladder symptoms, pelvic floor muscle strength, and quality of life in women with SUI.
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Silvestrin TM, Steenrod AW, Coyne KS, Gross DE, Esinduy CB, Kodsi AB, Slifka GJ, Abraham L, Araiza AL, Bushmakin AG, Luo X. An approach to improve the care of mid-life women through the implementation of a Women's Health Assessment Tool/Clinical Decision Support toolkit. WOMEN'S HEALTH (LONDON, ENGLAND) 2016; 12:456-464. [PMID: 27558508 PMCID: PMC5373265 DOI: 10.1177/1745505716664742] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 07/12/2016] [Accepted: 07/14/2016] [Indexed: 11/17/2022]
Abstract
The objectives of this study are to describe the implementation process of the Women's Health Assessment Tool/Clinical Decision Support toolkit and summarize patients' and clinicians' perceptions of the toolkit. The Women's Health Assessment Tool/Clinical Decision Support toolkit was piloted at three clinical sites over a 4-month period in Washington State to evaluate health outcomes among mid-life women. The implementation involved a multistep process and engagement of multiple stakeholders over 18 months. Two-thirds of patients (n = 76/110) and clinicians (n = 8/12) participating in pilot completed feedback surveys; five clinicians participated in qualitative interviews. Most patients felt more prepared for their annual visit (69.7%) and that quality of care improved (68.4%) while clinicians reported streamlined patient visits and improved communication with patients. The Women's Health Assessment Tool/Clinical Decision Support toolkit offers a unique approach to introduce and address some of the key health issues that affect mid-life women.
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Rocha ACP, Feliciano AB, Carbol M, Candolo C, Callegari FVR. Conhecimentos, atitudes e prática de médicos e enfermeiros da Estratégia Saúde da Família em relação à incontinência urinária feminina. REVISTA BRASILEIRA DE MEDICINA DE FAMÍLIA E COMUNIDADE 2016. [DOI: 10.5712/rbmfc11(38)1146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Objetivo: Analisar conhecimentos, atitudes e prática de médicos e enfermeiros da Estratégia Saúde da Família (ESF) em relação à incontinência urinária (IU) feminina. Métodos: O estudo foi realizado nas 19 equipes da ESF de um município no interior paulista, as quais possuíam 41 profissionais elegíveis (22 médicos e 19 enfermeiros). Foi desenvolvido e utilizado um questionário autoaplicável com questões sobre conhecimentos, atitudes e prática dos profissionais na atenção às mulheres com IU. Resultados: Responderam ao questionário 33 profissionais (80% da população alvo), sendo 15 médicos e 18 enfermeiros. A maioria dos participantes possuía um nível de conhecimento adequado em relação à propedêutica clínica da IU e considerou que suas atribuições englobam a investigação diagnóstica e o tratamento da IU não complicada. Entretanto, uma parcela significativa desconhecia os exames complementares e a conduta terapêutica para a abordagem inicial das mulheres com IU, principalmente naquelas com IU de Urgência. Quanto à prática, um número expressivo desses profissionais não prescrevia exercícios de fortalecimento do assoalho pélvico, não realizava ações de educação em saúde com as mulheres ou promovia atividades de educação permanente com a equipe de trabalho. Conclusão: Os déficits de investigação diagnóstica e tratamento da IU feminina identificados sugerem a necessidade de educação permanente e integração de equipes de apoio matricial à ESF, a fim de promover um cuidado mais integral à população. Tais equipes podem ser provenientes dos Núcleos de Apoio à Saúde da Família (NASF) e/ou de parcerias com as universidades locais.
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Abstract
Incontinence-associated dermatitis (IAD) is a condition often encountered by dermatologists. IAD is an inflammatory skin condition secondary to prolonged urine exposure-it is a dermatologic sequela of urinary incontinence. Incontinence should not be dismissed simply as an age-related disorder; rather, it is due to a number of pathologic conditions that can be either reversible or manageable. It is thus critical to identify and treat the underlying causes of urinary incontinence. Clinical management of this common medical issue restores normality to patients' lives while also preventing future dermatologic complications. In this article, we aim to provide dermatologists with an overview of IAD and an approach to the diagnosis and initial management of urinary incontinence.
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Affiliation(s)
- Malika Ladha
- 1 Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Adrian Wagg
- 2 Division of Geriatric Medicine, University of Alberta, Edmonton, AB, Canada
| | - Marlene Dytoc
- 3 Division of Dermatology, University of Alberta, Edmonton, AB, Canada
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Silvestrin T, Steenrod A, Coyne K, Gross D, Esinduy C, Kodsi A, Slifka G, Abraham L, Araiza A, Bushmakin A, Luo X. Outcomes of implementing the women's health assessment tool and clinical decision support toolkit. ACTA ACUST UNITED AC 2016; 12:313-23. [PMID: 27188377 DOI: 10.2217/whe.16.3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
AIM To evaluate outcomes after implementing the women's health assessment tool (WHAT) and clinical decision support toolkit during annual well-women visits. METHODS An observational project involved women aged 45-64 years attending one of three medical sites in Washington (WA, USA). Responses to the WHAT questionnaire and patients' health resource utilization prepost toolkit implementation were analyzed. RESULTS A total of 110 women completed the WHAT questionnaire. Majority of women were postmenopausal (77.3%) and experienced depressive mood (63.6%), hot flashes (61.8%) or anxiety (60.9%) in the last 3 months. There was a 72.2% increase in the number of diagnoses made during the annual visit versus the previous 12 months. CONCLUSION The WHAT/clinical decision support toolkit helped identify conditions relevant to mid-life women.
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Care-Seeking for Stress Incontinence and Overactive Bladder Among Parous Women in the First Two Decades After Delivery. Female Pelvic Med Reconstr Surg 2016; 22:199-204. [PMID: 26945268 DOI: 10.1097/spv.0000000000000262] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study aimed to establish the extent to which care-seeking for urinary incontinence is a function of symptom bother; and to identify bother-score thresholds that predict care-seeking in the first 2 decades after delivery. METHODS In this longitudinal cohort, women were assessed annually for symptom bother related to stress urinary incontinence (SUI) and overactive bladder (OAB), as well as for recent episodes of care-seeking for urinary symptoms. Because the goal was to model care-seeking as a function of the woman's characteristics at her prior visit, women who completed 2 or more consecutive visits were included. The population was randomly divided into "training" (model development) and "testing" (model validation) sets. The predictive model was developed in the training set. For SUI and OAB bother scores, we identified thresholds to define statistically distinct probabilities of care-seeking. A multivariable model was created, including SUI and OAB bother categories as well as characteristics associated with care seeking at the P < 0.05 level. The resultant prediction model was then applied to the "testing set"; predicted and observed care-seeking frequencies were compared. RESULTS Care-seeking was strongly associated with SUI and OAB bother. We defined 3 categories for OAB score and 4 categories for SUI score. The resulting 12 risk categories were then collapsed into 5 distinct risk-groups. These groups accurately predicted care-seeking in the testing set (area under the receiver operating curve, 0.760; 95% confidence interval, 0.713-0.807). Inclusion of other risk factors did not improve the model. CONCLUSIONS Symptom bother is a strong determinant of care-seeking in the first 2 decades after delivery. These results define 5 ordinal categories that predict seeking care for urinary symptoms in a community population.
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Elder American Indian women's knowledge of pelvic floor disorders and barriers to seeking care. Female Pelvic Med Reconstr Surg 2016; 21:34-8. [PMID: 25185612 DOI: 10.1097/spv.0000000000000103] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The objectives of this study are to evaluate urinary incontinence and pelvic organ prolapse knowledge among elder southwestern American Indian women and to assess barriers to care for pelvic floor disorders through community-engaged research. METHODS Our group was invited to provide an educational talk on urinary incontinence and pelvic organ prolapse at an annual meeting of American Indian elders. Female attendees aged 55 years or older anonymously completed demographic information and 2 validated questionnaires, the Prolapse and Incontinence Knowledge Questionnaire (PIKQ) and Barriers to Incontinence Care Seeking Questionnaire (BICS-Q). Questionnaire results were compared with historical controls from the original PIKQ and BICS-Q validation study. RESULTS One hundred forty-four women completed the questionnaires. The mean age was 77.7 ± 9.1 years. The mean (SD) for PIKQ of urinary incontinence score was 6.6 (3.0) (similar to historic gynecology controls 6.8 [3.3], P = 0.49), and the mean (SD) for PIKQ on pelvic organ prolapse score was 5.4 (2.9) (better than historic gynecology controls 3.6 [3.2], P < 0.01). Barriers to care seeking reported by the elder women were highest on the BICS-Q subscales of "cost" and "inconvenience." CONCLUSIONS Urinary incontinence knowledge is similar to historic gynecology controls, and pelvic organ prolapse knowledge is higher than historic gynecology controls among elder southwestern American Indian women. American Indian elder women report high levels of barriers to care. The greatest barriers to care seeking for this population were related to cost and inconvenience, reflecting the importance of assessing socioeconomic status when investigating barriers to care. Addressing these barriers may enhance care-seeking southwestern American Indian women.
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Wright B, Emmanuel A, Athanasakos E, Parmar N, Parker G, Green B, Tailby E, Chandler H, Cushnie J, Pembroke J, Saruchera Y, Vashisht A, Day R. Women's views on autologous cell-based therapy for post-obstetric incontinence. Regen Med 2016; 11:169-80. [PMID: 26876964 DOI: 10.2217/rme.15.88] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
AIM Fecal and urinary incontinence are devastating consequences of obstetric-related perineal injury. The aim of the present study is to determine acceptability to parous women of autologous cell-based therapy for fecal and urinary incontinence that arises due to pelvic diaphragm tearing during vaginal childbirth. MATERIALS & METHODS A multiple choice questionnaire survey was offered to 76 parous women at the Maternity Unit, University College Hospital, London, UK. Seventy completed questionnaires - response rate: 92%. RESULTS In total, 84% of women indicated a willingness to accept autologous cell-based therapy for obstetric injury-induced incontinence rather than surgery. CONCLUSION These observational data provide an indication of likely acceptance of autologous cell-based therapies for birth injury incontinence and will help with designing new therapeutic approaches.
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Affiliation(s)
- Bernice Wright
- Applied Biomedical Engineering Group, University College London, Rockefeller Building, 21 University Street, London, WC1E 6JJ, UK
| | - Anton Emmanuel
- GI Physiology Unit, University College Hospital, 235 Euston Road, London, NW1 2BU, UK
| | - Eleni Athanasakos
- GI Physiology Unit, University College Hospital, 235 Euston Road, London, NW1 2BU, UK
| | - Nina Parmar
- Applied Biomedical Engineering Group, University College London, Rockefeller Building, 21 University Street, London, WC1E 6JJ, UK
| | - Georgina Parker
- University College Hospital, Elizabeth Garrett Anderson Wing, Institute for Women's Health, London, WC1E 6BD, UK
| | - Belinda Green
- University College Hospital, Elizabeth Garrett Anderson Wing, Institute for Women's Health, London, WC1E 6BD, UK
| | - Emma Tailby
- University College Hospital, Elizabeth Garrett Anderson Wing, Institute for Women's Health, London, WC1E 6BD, UK
| | - Heidi Chandler
- University College Hospital, Elizabeth Garrett Anderson Wing, Institute for Women's Health, London, WC1E 6BD, UK
| | - Julyette Cushnie
- University College Hospital, Elizabeth Garrett Anderson Wing, Institute for Women's Health, London, WC1E 6BD, UK
| | - June Pembroke
- University College Hospital, Elizabeth Garrett Anderson Wing, Institute for Women's Health, London, WC1E 6BD, UK
| | - Yvonne Saruchera
- University College Hospital, Elizabeth Garrett Anderson Wing, Institute for Women's Health, London, WC1E 6BD, UK
| | - Arvind Vashisht
- University College Hospital, Elizabeth Garrett Anderson Wing, Institute for Women's Health, London, WC1E 6BD, UK
| | - Richard Day
- Applied Biomedical Engineering Group, University College London, Rockefeller Building, 21 University Street, London, WC1E 6JJ, UK
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Bridging the gap: determinants of undiagnosed or untreated urinary incontinence in women. Am J Obstet Gynecol 2016; 214:266.e1-266.e9. [PMID: 26348382 DOI: 10.1016/j.ajog.2015.08.072] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Revised: 08/07/2015] [Accepted: 08/31/2015] [Indexed: 01/01/2023]
Abstract
BACKGROUND More than a third of middle-aged or older women suffer from urinary incontinence, but less than half undergo evaluation or treatment for this burdensome condition. With national organizations now including an assessment of incontinence as a quality performance measure, providers and health care organizations have a growing incentive to identify and engage these women who are undiagnosed and untreated. OBJECTIVE We sought to identify clinical and sociodemographic determinants of patient-provider discussion and treatment of incontinence among ethnically diverse, community-dwelling women. STUDY DESIGN We conducted an observational cohort study from 2003 through 2012 of 969 women aged 40 years and older enrolled in a Northern California integrated health care delivery system who reported at least weekly incontinence. Clinical severity, type, treatment, and discussion of incontinence were assessed by structured questionnaires. Multivariable regression evaluated predictors of discussion and treatment. RESULTS Mean age of the 969 participants was 59.9 (±9.7) years, and 55% were racial/ethnic minorities (171 black, 233 Latina, 133 Asian or Native American). Fifty-five percent reported discussing their incontinence with a health care provider, 36% within 1 year of symptom onset, and with only 3% indicating that their provider initiated the discussion. More than half (52%) reported being at least moderately bothered by their incontinence. Of these women, 324 (65%) discussed their incontinence with a clinician, with 200 (40%) doing so within 1 year of symptom onset. In a multivariable analysis, women were less likely to have discussed their incontinence if they had a household income < $30,000/y vs ≥ $120,000/y (adjusted odds ratio [AOR], 0.49, 95% confidence interval [CI], 0.28-0.86) or were diabetic (AOR, 0.71, 95% CI, 0.51-0.99). They were more likely to have discussed incontinence if they had clinically severe incontinence (AOR, 3.09, 95% CI, 1.89-5.07), depression (AOR, 1.71, 95% CI, 1.20-2.44), pelvic organ prolapse (AOR, 1.98, 95% CI, 1.13-3.46), or arthritis (AOR, 1.44, 95% CI, 1.06-1.95). Among the subset of women reporting at least moderate subjective bother from incontinence, black race (AOR, 0.45, 95% CI, 0.25-0.81, vs white race) and income < $30,000/y (AOR, 0.37, 95% CI, 0.17-0.81, vs ≥ $120,000/y) were associated with a reduced likelihood of discussing incontinence. Those with clinically severe incontinence (AOR, 2.93, 95% CI, 1.53-5.61, vs low to moderate incontinence by the Sandvik scale) were more likely to discuss it with a clinician. CONCLUSION Even in an integrated health care system, lower income was associated with decreased rates of patient-provider discussion of incontinence among women with at least weekly incontinence. Despite being at increased risk of incontinence, diabetic women were also less likely to have discussed incontinence or received care. Findings provide support for systematic screening of women to overcome barriers to evaluation and treatment.
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Re: Quality of Life (QoL) and Help-Seeking in Postmenopausal Women with Urinary Incontinence (UI): A Population Based Study. J Urol 2015. [DOI: 10.1016/j.juro.2015.04.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Cross W, Cant R, Manning D, McCarthy S. Addressing information needs of vulnerable communities about incontinence: a survey of ten CALD communities. Collegian 2015; 21:209-16. [PMID: 25632715 DOI: 10.1016/j.colegn.2013.04.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Urinary incontinence is a common and distressing condition. Using focus groups, we explored the views of ten ethnic language groups in Melbourne about knowledge and awareness of incontinence. The 218 participants (with or without incontinence) spoke with trained interpreters. Twenty focus group discussions of single and mixed sex groups were audio-recorded and transcribed into English. Narratives were analyzed using thematic analysis with open coding and also incorporated themes from literature. Participants' knowledge of incontinence was low and incontinence was thought to be an inevitable consequence of ageing. There was little understanding of treatments or assistance available under government-funded programmes. No group was aware of the national continence programme or phone helpline. Sensitivities of the topic plus language barriers in immigrant culturally and linguistically diverse communities may impose barriers to accessing help. Several groups thought they would cope with incontinence by themselves, while all groups suggested they would be able to discuss the condition with a doctor. Various preferences voiced about social limitations and permissible communications with others are described. Nurses should be aware of the needs and communication preferences of ethnic language groups regarding continence information and continence service delivery.
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Files JA, Mayer AP, Chutka DS. Urinary incontinence: not just a mid-laugh crisis. J Womens Health (Larchmt) 2015; 24:107-8. [PMID: 25531148 DOI: 10.1089/jwh.2014.5126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Affiliation(s)
- Julia A Files
- 1 Division of Women's Health-Internal Medicine, Mayo Clinic in Arizona , Scottsdale, Arizona
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Zohre M, Minoo P, Ali M. Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12): psychometric validation of the Iranian version. Int Urogynecol J 2014; 26:433-9. [DOI: 10.1007/s00192-014-2520-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2014] [Accepted: 09/18/2014] [Indexed: 11/24/2022]
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Xu D, Wang X, Li J, Wang K. The mediating effect of 'bothersome' urinary incontinence on help-seeking intentions among community-dwelling women. J Adv Nurs 2014; 71:315-25. [PMID: 25212267 DOI: 10.1111/jan.12514] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2014] [Indexed: 11/29/2022]
Abstract
AIM To explore the mediating effect of bother of urinary incontinence between urinary incontinence severity and help-seeking intentions and detect whether the International Consultation on Incontinence Questionnaire-UI Short Form could be a valid measure to delineate bothersome urinary incontinence. BACKGROUND Urinary incontinence is a common condition among women, which has a profound adverse effect on quality of life. However, many of them experiencing significant clinical symptoms do not seek medical help. DESIGN A cross-sectional survey design. METHODS Women with urinary incontinence (N = 620) from three randomized selected community health service centres from May-October 2011 participated in the study. Data were collected using a pencil-and-paper questionnaire. Multivariate regression models were used to test the role of bother as a mediator in the relation between urinary incontinence severity and help-seeking intentions. Receiver operating characteristic analysis was used to find the best cut-off International Consultation on Incontinence Questionnaire-UI Short Form score (range: 0-21) to delineate the bother of urinary incontinence. RESULTS Bothersome urinary incontinence mediated the relationship between urinary incontinence severity and help-seeking intentions. Age and duration of urine leakage had a negative association on help-seeking intentions, while educational level and previous help-seeking behaviours had a positive association. CONCLUSIONS Bother was a mediator in the relation between urinary incontinence severity and help-seeking intentions. The International Consultation on Incontinence Questionnaire-UI Short Form was a discriminative measure to delineate the bothersome urinary incontinence.
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Affiliation(s)
- Dongjuan Xu
- School of Nursing, Shandong University, Jinan, China; School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
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