Body mass index and adult female urinary incontinence

Summary The aim of the present investigation was to study the possible role of obesity in the etiology of adult female urinary incontinence (UI). A random population sample of 3,114 women aged 30–59 years were mailed a questionnaire concerning UI and, among other things, body weight and height. The overall rate of response was 85%, and the present analysis comprises 2,589 women who supplied information about their body weight and height. The period prevalence of all UI, stress UI, urge UI, and mixed stress and urge UI was 17%, 15%, 9%, and 7%, respectively. The mean body mass index (BMI) was 22.7 kg/m². Irrespective of other risk indicators, BMI was positively associated with UI prevalence (OR, 1.07/BMI unit; P<0.0001). BMI interacted with childbirth in predicting stress UI prevalence, with cystitis in predicting urge UI, and with both in predicting mixed UI. Stress UI proved to be the UI type most closely associated with BMI.     

Efficacy and safety of onabotulinumtoxinA injection in patients with refractory overactive bladder: First multicentric study in Turkish population

Aims

To investigate the efficacy and safety of intradetrusor onabotulinumtoxinA (onaBoNT‐A) injection in patients with overactive bladder (OAB) refractory to antimuscarinic treatment.

Methods

A total of 80 patients with OAB symptoms were enrolled in this prospective multicenter study and received 100 U intradetrusor onaBoNT‐A injection.The changes from baseline in the frequency of voiding, urge urinary incontinence (UI) and urge episodes, mean and maximum bladder capacities, uroflowmetry, post‐void residual urine volume (PVR), quality of life score, and treatment benefit scale score were assessed. The need for a second injection,and treatment‐related adverse events were also examined postoperatively.

Results

OnaBoNT‐A injection significantly decreased the UI episodes(P = 0.0001), the mean voiding frequency (P = 0.0001), and the urgency episodes (P = 0.0001) in the third month compared to baseline. Similarly, the mean bladder capacity, and maximal bladder capacity were increased (P < 0,05). The quality of life scores improved by 57.1% compared to the pre‐treatment rate (P = 0,0001). No significant change was observed in the PVR or maximum flow rate. Urinary retention developed in 3 (3.75%) patients and urinary infection and transient hematuria were observed in five patients (6.25%) each. The UI episodes, voiding frequency and urgency episodes were significantly lower at the 9th month than at baseline (all P = 0.0001). Overall 67% of the patients continued to experience benefits from the injection. Sixteen patients (20%) required a second injection in the third month. Eight patients were lost to follow‐up at the last visit in the 9th month, and 34 of the remaining 56 patients required a second injection at the 9th month. Cumulatively, 50 (63%) patients needed re‐injections.

Conclusions

Our results demonstrated that the onaBoNT‐A injection produced significant improvement in all OAB symptoms with a low incidence of treatment related adverse events.     

Urinary incontinence among community‐dwelling people aged 40 years or older in Japan: Prevalence,risk factors,knowledge and self‐perception

Background : Urinary incontinence (UI) is a common problem in adults, especially among the elderly. We examined the prevalence and risk factors of UI and potential factors hindering individuals from seeking treatment for UI among a community‐dwelling population aged over 40 years. Methods : Data were collected by mailing a 23‐item urinary incontinence questionnaire to a random sample of community‐dwelling individuals aged 40–75 years (n = 3500) in seven towns of Shiga Prefecture, Japan. Collected data were then used to estimate the prevalence of UI and to provide information regarding subtypes of UI, knowledge and self‐perception about UI. Results : The overall response rate was 52.5%. Prevalence of UI for male and female respondents were 10.5% and 53.7%, respectively. The incidence of urge incontinence increased as age increased in the male group. In women, stress incontinence was prevalent at all ages and the incidence of urge incontinence increased over 70 years of age. Urinary incontinence was more likely as activities of daily living limitations and cystitis increased. Women with a history of hysterectomy or diabetes mellitus and men who had stroke were at increased risk for UI. Of those who reported UI, only 3% had ever consulted doctors or other health care professionals concern‐ ing it, 25% recognized their condition as a disease and 38% considered it curable by appropriate treatments. In addition, 63% regarded UI as an unavoidable consequence of aging, 63% con‐ sidered their condition was embarrassing and 54% were reluctant to seek treatment from a health professional. Conclusions : Although UI is common among community‐dwelling individuals over 40 years of age, the majority of affected individuals remained untreated due to lack of knowledge and/or a negative perception of UI. Thus, community education on UI may be needed to increase the number of UI patients who receive treatment.     

The menopause and urinary incontinence

The objective was to study the possible role of the menopause in adult female urinary incontinence (UI) etiology, using a cross-sectional population study comprising a random sample of adult females and self-reported data based on postal questionnaires.The study group comprised 915 women who reported continued menstruation and 636 women who had stopped menstruation after the age of 39; in total, 1551 women aged 40–59 years, from the Municipality of Aarhus, Denmark. Ooophorectomized or hysterectomized women not reporting menstruation were excluded.The main outcome measures were the period prevalence in 1987 of episodes of stress and urge urinary incontinence; prevalence of menopause and exposure to childbirth, gynecologic surgery, cystitis and obesity as indicated by body mass index more than 29; prevalence relative risks, as indicated by odds ratio of UI conditional on menopause and other prevalence risk indicators.The 1987 period prevalences of stress and urge urinary incontinence were 15.9% and 8.7%, respectively. Forty-one percent had ceased to menstruate. Irrespective of the UI risk indicators mentioned, UI prevalence was significantly raised from 1 year before until 1 year after the year of final menstruation. The findings suggest perimenopausal processes rather than the menopause in general to be responsible for an increased risk of developing UI. The elevation of UI prevalence in the perimenopause may reflect the adjustment of the female continence mechanism to function with a lower estrogen level than previously. Perimenopausal processes seem to contribute much less than surgical operations, for example, to the amount of UI in middle-aged women. This may affect assessment of the relevance of estrogen supplementation of menopausal UI patients aged 40–59.     

The improvement in pelvic floor symptoms with weight loss in obese women does not correlate with the changes in pelvic anatomy

Introduction and hypothesis

It has been suggested that weight reduction decreases the frequency of urinary incontinence (UI) episodes. However, it is not known if this improvement is associated with anatomical changes in the pelvis. The aim of this study was to investigate the effects of weight loss on UI episodes and pelvic floor anatomy.

Methods

Three hundred seventy-eight overweight/obese women were randomly allocated either to behavioral weight loss or to structured education programs. The patients were evaluated by voiding diary, Pelvic Floor Distress Inventory (PFDI), and Pelvic Organ Prolapse Quantification (POP-Q) system at baseline and after 6 months.

Results

The women in the intervention group had a mean weight loss of 9.4 %, whereas the weight in the control group remained almost the same (P?P?Conclusions Weight reduction provides improvement in episodes of UI, decreases the incidence of drops of urine leakage, and increases quality of life related to pelvic floor symptoms. However, there are little to no changes in the parameters of the POP-Q system with weight reduction.     

Effects of bariatric surgery on urinary and sexual function

Study Type – Symptom prevalence (non‐consecutive cohort)
Level of Evidence 4 What’s known on the subject? and What does the study add? Obesity is a known risk factor for Urinary Incontinence. Non surgical weight loss has been shown to reduce Urinary Incontinence, but there is only limited evidence for surgically induced weight loss. This study aims to clarify the effects of surgically induced weight loss on urinary and erectile function.

OBJECTIVE

To investigate the effects of weight loss and time post laparoscopic gastric banding surgery (LGB) on urinary and sexual function.

MATERIALS AND METHODS

653 females and 145 males who underwent LGB over the last 10 years at a single centre in Australia were contacted by post and asked to complete validated questionnaires.

RESULTS

The pre‐surgery body‐mass index (BMI) was higher in males than females (47.3 vs 43.5); 65% of the females and 24% of males previously had some degree of urinary incontinence (UI). There were significant weight and BMI losses in males and females (23.2 kg and 7.51 vs 22.7 kg and 8.28; P < 0.0001). In females there were significant improvements in the ICIQ‐SF (P= 0.0008) and Quality of Life (P < 0.0001) scores. For each kilogram lost there was a 0.05 improvement in the ICIQ score (P= 0.03) in females. There were also postoperative improvements in all symptoms of UI and stress incontinence in females but urge incontinence worsened, when adjusted for weight loss. In males there was no improvement in UI with weight loss after LGB. There was no relationship with time and UI in either gender; 83.3% of males reported a degree of ED before LGB. There was improvement in the IIEF score in males post LGB but there was worsening of erectile index (P= 0.005) and orgasmic function (P= 0.002) when adjusted for time. More males had started using phosphodiesterase type 5 inhibitors, post‐LGB.

CONCLUSIONS

Surgically induced weight loss by LGB improved overall UI, quality of life and stress incontinence in females but urge incontinence worsened. There was no improvement in UI with weight‐loss or overall sexual function after LGB in males. However, erectile index and orgasmic function worsened when adjusted for time. Further evaluation is required by means of larger prospective studies involving urodynamic testing.     

Urinary incontinence after multiple gestation and delivery: impact on quality of life

An anonymous 77-item urogenital symptom questionnaire was administered to 769 women with a history of previous multifetal gestation and delivery, including long forms of the Incontinence Impact Questionnaire (IIQ) and Urogenital Distress Inventory (UDI). IIQ and UDI scores were analyzed using univariate and multivariate regression to determine the impact of incontinence on quality of life (QOL). Mean age was 37 years (22–75), and nearly half [49.8% (365)] reported at least one type of incontinence. Higher mean UDI scores were reported by women with stress incontinence (SI) (12.3 vs 4.7, p=0.0001), urge incontinence (UI) (14.9 vs 5.7, p=0.0001), and mixed incontinence (15.1 vs 6.2, p=0.0001) compared to continent women. Similarly, higher mean IIQ scores were associated with SI (6.9 vs 1.9, p=0.0001), UI (9.4 vs 2.2, p=0.0001), and mixed incontinence (9.3 vs 2.7, p=0.0001). In conclusion, among mothers of multiples, stress and urge urinary incontinence were associated with strongly adverse effects on QOL at a young age.     

Factors influencing self-perceived disease severity in women with stress urinary incontinence combined with or without urge incontinence

AIMS: The aim of this study was to assess the impact of patient-perceived disease severity (PPDS) on the quality of life (QoL) of women with urinary incontinence (UI) and to identify factors predicting PPDS. METHODS: A total of 109 women (mean age 54.9; range 31-77) with stress UI combined with or without urge UI were included in the primary analyses. The incontinence quality of life (I-QoL) devised during the course of this study was used to assess the QOL impact of UI. RESULTS: PPDS of women with UI increased as I-QoL scores decreased (P<0.001). When analyzed by patient characteristics and objective test results, PPDS increased only with the number of episodes (P=0.005) and pad test weight increased (P=0.010). By multivariate regression analysis, patients who complained of UI "three to four times a day or more" had 6.4-fold higher risk (P=0.027) of perceiving that their symptoms were more severe than those who complained of a UI "one to two times per week or less." Patients with a pad test weight of >25 g had a 4.7-fold higher risk of perceiving their symptoms were more severe than those with a pad test weight of <15 g. CONCLUSIONS: Our results suggest that the frequency of UI episodes and the volume of urine loss are associated with PPDS. In addition, the I-QoL scores deteriorated significantly as the PPDS of incontinence increased. Thus, PPDS may impact on the QoL of women with stress UI combined with or without urge UI.     

Prevalence and the associated trigger factors of urinary incontinence among 5000 black women in sub-Saharan Africa: findings from a community survey

Study Type – Symptom prevalence (prospective cohort) Level of Evidence 1b

OBJECTIVE

? To determine the prevalence and describe possible trigger factors of urinary incontinence (UI) among adult women in a Nigerian community.

PATIENTS AND METHODS

? The present study comprised a household community survey conducted among 5001 women aged ≥18 years. Cluster multistage sampling was used to select eligible respondents. Information was obtained by an interviewer who administered a structured questionnaire on sociodemographics, obstetric and gynaecological characteristics, leakage of urine and trigger factors.

RESULTS

? The mean ± SD age of the women was 33.2 ± 14.7 years. The proportion of women currently experiencing leakage was 2.8% (95% CI, 2.6–3.0). The types of incontinence reported by women currently leaking included stress incontinence (2.3%), urge incontinence (1%) and mixed (0.6%). ? Severe incontinence was reported in 0.5% of women, 0.1% had moderate incontinence, whereas 2.2% had mild incontinence. ? Women with history of vaginal delivery only were approximately two‐fold more likely (95% CI OR, 1.11–3.02), and those who delivered by other modes over four‐fold more likely (95% CI OR, 1.96–9.27), than nulliparous women to report currently leaking urine.

CONCLUSIONS

? The present study shows a prevalence of UI comparable to other settings, and the commonest type is stress is found to be UI. ? The mode of delivery is a significant correlate of UI amongst Nigerian women.     

Quantitative assessment of fascia preservation improves the prediction of membranous urethral length and inner levator distance on continence outcome after robot‐assisted radical prostatectomy

Aims

To determine whether preoperative prostate/pelvic anatomical structures and intraoperative fascia preservation (FP) predict continence recovery after robot‐assisted radical prostatectomy (RARP).

Methods

Between January 2012 and March 2016, 439 prostate cancer (PCa) patients with normal preoperative continence were retrospectively included. FP score was defined as the extent of FP from base to apex of the prostate, quantitatively assessed by the surgeon. Anatomical prostate structures were measured on endorectal preoperative Magnetic Resonance Imaging. The International Consultation on Incontinence Questionnaire‐Short Form (ICIQ‐SF) was used to assess urinary incontinence (UI). Cox analysis was used to determine predictive factors for early continence recovery. Finally a binary logistic regression analysis was performed to develop a risk calculator.

Results

At a median follow up of 12.1 months 50.8% of men reported UI. In the Cox multivariate analysis longer membranous urethral length (MUL; P < 0.0001; OR 1.309; CI 1.211, 1.415) and shorter inner levator distance (ILD; P < 0.0001; OR 0.904; CI 0.85, 0.961) were predictors of earlier continence recovery. In the multivariate binary logistic regression analysis longer MUL (P < 0.0001; OR 1.565, CI 1.362, 1.798), shorter ILD (P < 0.0001; OR 0.819, CI 0.742, 0.904) and higher FP score (P = 0.024; OR 1.089, CI 1.011, 1.172) were independent predictors of continence outcome. The risk calculator predicted continence recovery between 1.3% and 99%.

Conclusions

Preoperative longer MUL and shorter ILD, but also intraoperative FP independently improve continence recovery after RARP. The risk calculator could be used to identify patients at high risk of UI.     

Differences in urinary incontinence between Hispanic and non-Hispanic white women: a population-based study

OBJECTIVE

To compare the prevalence of urinary incontinence (UI) between Hispanic and non‐Hispanic White women in a population‐based study.

SUBJECTS AND METHODS

The prevalence of moderate to severe UI, defined as Sandvik severity score of ≥3, was assessed in relation to ethnicity by stratification, age adjustment and logistic regression models among 250 Hispanic and 491 non‐Hispanic White women in Colorado, USA, who were participants in a breast cancer case‐control study.

RESULTS

Hispanic women reported more stress UI (odds ratio 1.7, P = 0.005) and mixed UI (odds ratio 1.8, P = 0.005) than did non‐Hispanic White women. These higher prevalences were largely associated with ethnic differences in parity, body mass index, diabetes, hysterectomy and bilateral oopherectomy.

CONCLUSIONS

The prevalence of moderate to severe UI in Colorado is higher among Hispanic women than among non‐Hispanic white women. This difference is largely compatible with differences in reproductive history, adiposity and diabetes.     

Risk factors for urinary incontinence in Taiwanese women aged 60 or over

To determine risk factors of urinary incontinence (UI) in Taiwanese women aged 60 or over, face-to-face interviews with 1,517 women, selected by a multistage random method, were completed. The prevalence of UI in this age group was 29.8%. Factors and their prevalence associated with UI were age [odds ratio (OR)=1.04 per year], diabetes mellitus (39.8%, p = 0.002), hypertension (39.5%, p = 0.001), abdominal gynecological surgery (41.4%, p = 0.001), hysterectomy (42.4%, p = 0.003), history of drug allergy (41.3%, p = 0.001), smoking (45.5%, p = 0.010), hormone replacement therapy (41.5%, p = 0.026), and high body mass index (OR = 1.05 per unit). Alcohol consumption and marriage did not increase the risk of UI. UI is a common and costly problem in elderly women. It diminishes the quality of life of the affected women. Of the associated factors that are preventable, modifiable, or controllable, smoking, prior hysterectomy, and obesity may have the greatest impact on the prevalence of UI.     

A self-directed home biofeedback system for women with symptoms of stress, urge, and mixed incontinence.

PURPOSE: To evaluate a self-directed home biofeedback treatment system in a group of community dwelling, otherwise healthy women with symptoms of stress, urge, and mixed urinary incontinence (UI). SETTING AND SUBJECTS: Fifty-five women, aged 25 to 81 years, participated in the study. METHODS: Initial evaluation included a self-reported continence assessment, a 24-hour bladder and fluid habits diary, severity indices for stress and urge UI, and assessment of pelvic floor strength using a pneumatic biofeedback device. Subjects completed a 16-week self-directed program. Assessment and severity index data were self-reported using a continence assessment form, a 24-hour bladder habit and fluid form, and stress and urge incontinence severity indices. Strength level of the trainer, number of digital bands lit on the screen during contraction, number of sessions, and program (starter, intermediate, advanced, or maintenance) were recorded on data sheets. INSTRUMENTS: The treatment system includes an 8-minute educational and motivational video; a journal for education, instructions, and daily documentation forms; and a home biofeedback trainer with pneumatic vaginal sensors that displays the strength of pelvic muscle contraction. RESULTS: Forty-four women completed the 16-week program. At the end of treatment, 19 (43%) were dry and 16 (36%) reported 50% or more improvement in number of leaks per day, number of voids per day, or both. Women with stress leakage experienced a significant reduction in the number of incontinent episodes per day and the mean severity index of incontinence (P < .001). Participants with urge UI experienced a significant reduction in the mean number of voids per day and mean severity index for UI (P < .001). Younger subjects were more likely to improve when compared with older participants, but no significant differences were found when comparing women who take estrogen with those who do not take estrogen or when comparing those with a history of bladder surgery with those who had no previous surgery. CONCLUSIONS: These data suggest that self-selected healthy women with symptoms of urge, stress, and mixed incontinence can improve their symptoms and lower their severity index with a minimal intervention, comprehensive, self-directed home biofeedback continence system.     

Childhood dysfunctional voiding is differentially associated with urinary incontinence subtypes in women

Purpose  

To estimate the relationship between the history of childhood dysfunctional voiding and urinary incontinence (UI) in adult women with and without clinical UI and to estimate its relationship with stress, urge, and mixed UI.     

Prevalence of urinary incontinence in Korean women: results of a National Health Interview Survey

Objectives We determined the prevalence and types of urinary incontinence (UI) in Korean women and analyzed their attitude toward treatment. Methods This national survey was conducted as part of the Korean National Health Interview Survey to evaluate the prevalence of UI in Korean women between April and June 2005. In 13,345 Korean households, 13,484 women aged 19 years or older were interviewed by census takers. The subjects were asked about the type of UI that they had experienced and their treatment. UI was classified as “stress,” “urge,” “mixed” (stress and urge), or “other.” Results The overall prevalence of UI in the subjects was 24.4%. Of those women, 48.8% reported stress UI only; 7.7%, urge UI only; 41.6%, mixed UI; and 1.9%, other type of UI. The prevalence of UI increased with age. Only 12.6% of the women with UI had sought medical care, and only 0.8% had undergone surgery for UI. Self-reported depression was higher in women with UI than in those without that disorder, and UI was more prevalent in women who were married, unemployed, and undereducated. According to national population data estimated by weighted UI numbers, about 4.2 million Korean women aged 19 years or older have experienced UI. Conclusions The prevalence of UI among women aged 19 years or older in Korea was 24.4%, and stress UI was the most prevalent type. Many women with UI did not seek medical treatment for that condition.     

Hidden female urinary incontinence in urology and obstetrics and gynecology outpatient clinics in Turkey: what are the determinants of bothersome urinary incontinence and help-seeking behavior?

The purpose of this study was to assess the prevalence of female urinary incontinence (UI) and risk factors of bothersomeness and help-seeking behavior of hidden female UI in urology and obstetrics and gynecology outpatient clinics. This multicentric and cross-sectional study was conducted as a part of the Turkish Overactive Bladder Study. Female patients (n = 5,565) who were referred with complaints other than UI and overactive bladder symptoms were surveyed using the International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF) with supplementation of five more questions. The crude prevalence of UI was found to be 35.7%. The prevalence of frequent and severe incontinence was 8.2 and 6.8%, respectively. The mean age of incontinent patients was significantly higher (p < 0.001). The prevalence of stress, urge, and mixed UI was 39.8, 24.8, and 28.9%, respectively. More than half (53%) of incontinent patients were not bothered by UI, and only 12% of incontinent patients had previously sought medical help for their problem. Frequency, severity, and type of UI were independent factors for predicting bothersome UI, while only bothersomeness increased help-seeking behavior. The ICIQ-SF score of 8 has been found to be the best cutoff value to delineate the bothersome UI. Although the crude prevalence of female UI was found to be high, bothersome UI was not so common. The majority of incontinent female patients did not seek medical help. Frequency, severity, and mixed type of UI were found to be the determinants of bothersome UI for which the ICIQ-SF cutoff score of 8 was obtained.     

A study of lower urinary tract symptoms for the Korean women aged 30 and over

The purposes of this study were (1) to identify the prevalence of urinary incontinence (UI) and lower urinary tract symptoms (LUTS) for Korean women, (2) to evaluate the LUTS scores of the subjects in relation with each UI patterns and general characteristics, and (3) to identify affecting factors developing LUTS by using self-administered questionnaire. Community-based cross-sectional study was conducted for 3,371 women aged 30 to 89 years old who were allocated at six provinces in South Korea. UI and LUTS were assessed by validated symptom scales including the International Prostate Symptom Score. Of all the respondents, 63.4% had experienced UI more than once a month during the prior 12 months. Among the respondents, 36.6% had no UI, 47.5% had stress UI, 0.4% had urge UI, and 15.5% had mixed UI. The mean LUTS score of the total respondents was 7.8±4.1. The LUTS was significantly predicted by age (p<.0001) and mixed UI (p<.0001), and 79.4% of variance in LUTS was explained. The highest LUTS scores were shown in the subjects with mixed UI, and we found that LUTS scores increased with age.