Stress urinary incontinence among women who underwent surgical treatment due to abdominal hernias

OBJECTIVES: Biochemical modification and resulting biomechanical disfunction of the connective tissue are believed to contribute to the pathogenesis of both stress urinary incontinence and abdominal hernias. Since the coincidence between this disorders may be anticipated, the goal of our study was to investigate the occurrence of stress urinary incontinence among women who underwent the surgical treatment of abdominal hernias. MATERIALS AND METHODS: Forty seven women who participated into the study were divided into two groups. The investigated group consisted of 23 women who underwent surgical treatment of femoral, inguinal or umbilical hernias, whereas the control group comprised 24 women after cholecystectomy due to cholelithiasis. Data concerning stress urinary incontinence and associated risk factors were obtained using Gaudenz's questionnaire. RESULTS: Stress urinary incontinence was reported by 34.8% of women after hernioplasty and 33.3% after cholecystectomy. The difference was not statistically significant. We found no association between known risk factors of stress urinary incontinence, as: age, weight, history regarding vaginal delivery and gynecological surgery, and occurrence of incontinence. CONCLUSION: The history of the surgical treatment of abdominal hernias is not a risk factor of stress urinary incontinence in women.     

上海市成年女性尿失禁的流行病学研究

目的:了解上海市成年女性尿失禁(UI)的患病率及相关高危因素。方法:2012年1月至9月采用UI调查问卷对上海市城区和农村成年女性进行横断面调查,同时调查UI相关流行病学因素,调查采用一对一问答方式。共完成调查问卷7884份,使用多因素Logistic回归分析方法确定UI高危因素。结果:上海市成年女性的UI患病率为28.7%,其中压力性尿失禁(SUI)患病率最高,为23.5%,混合性尿失禁(MUI)为2.5%,急迫性尿失禁(UUI)为2.1%,UI患病率随着年龄增高而逐渐增加。绝经(OR=1.10)、阴道分娩次数≥2次(OR=1.49)、妊娠超过20周次数≥2次(OR=1.34)、首次阴道分娩年龄20岁(OR=1.58)、盆腔手术史(OR=1.38)、最大新生儿出生体重4000g(OR=2.66)、低教育程度(OR=1.14)、器械助产(OR=2.75)、体重指数(BMI)≥30kg/m2(OR=2.37)、高血压(OR=1.33)及糖尿病(OR=1.14)均为高危因素。结论:上海市成年女性UI患病率较高,以SUI为主,患病率随年龄增大而上升。产科因素为UI发病主要高危因素。     

Urodynamic investigation of women operated on for genuine stress incontinence

Anterior colporrhaphy (Kelly-Stoeckel suture) was performed on 22 women suffering from grade-I or grade-II genuine stress incontinence. Urodynamic investigation was performed on every patient before surgery and 6 months postoperatively. 21 patients were cured and 1 patient improved. After operation the functional urethral length was increased by 28.8%, and urethrovesical pressure transmission was improved by 22.9%. Maximum urethral closure pressure decreased postoperatively by 21.1%. Pressure transmission was clearly improved by the surgical intervention and urinary continence was restored in spite of the fact that maximal urethral closure pressure decreased. Based on these results it is suggested to consider performing anterior colporrhaphy in cases of weak urethral closure pressure, because of the increased risk of worsening the complaints of these patients. Copyright Copyright 1999 S. Karger AG, Basel     

High costs of urinary incontinence among women electing surgery to treat stress incontinence

OBJECTIVE: To estimate costs for incontinence management, health-related quality of life, and willingness to pay for incontinence improvement in women electing surgery for stress urinary incontinence. METHODS: A total of 655 incontinent women enrolled in the Stress Incontinence Surgical Treatment Efficacy Trial, a randomized surgical trial. Baseline out-of-pocket costs for incontinence management were calculated by multiplying self-report of resources used (supplies, laundry, dry cleaning) by national resource costs (USD2,006). Health-related quality of life was estimated with the Health Utilities Index Mark 3. Participants estimated willingness to pay for 100% improvement in incontinence. Potential predictors of these outcomes were examined by using multivariable linear regression. RESULTS: Mean age was 52+/-10 years, and mean number of weekly incontinence episodes was 22+/-21. Mean and median (25%, 75% interquartile range) estimated personal costs for incontinence management among all women were USD14+/-USD24 and USD8 (interquartile range USD3, USD18) per week, and 617 (94%) women reported any cost. Costs increased significantly with incontinence frequency and mixed compared with stress incontinence. The mean and median Health Utilities Index Mark 3 scores were 0.73+/-0.25 and 0.84 (interquartile range 0.63, 0.92). Women were willing to pay a mean of USD118+/-USD132 per month for complete resolution of incontinence, and willingness to pay increased significantly with greater expected incontinence improvement, household income, and incontinent episode frequency. CONCLUSION: Urinary incontinence is associated with substantial costs. Women spent nearly USD750 per year out of pocket for incontinence management, had a significant decrement in quality of life, and were willing to pay nearly USD1,400 per year for cure.     

Burden of stress urinary incontinence for community-dwelling women

OBJECTIVE: The purpose of this study was to better understand the subjective bothersomeness of stress urinary incontinence symptoms and their impact on the quality of life of community-dwelling women. STUDY DESIGN: We conducted a mail survey of 605 women in the United States who reported symptoms of stress urinary incontinence. RESULTS: More than three fourths of the respondents reported their symptoms to be bothersome, with approximately 29% reporting their symptoms to be moderately to extremely bothersome. The odds of moderate-to-extreme bother decreased with age and increased with symptom severity. Concerns about social embarrassment were evident. CONCLUSION: Stress urinary incontinence symptoms can impose a significant burden on the women who have them. The results reinforce the need for health care professionals to be proactive in questioning and educating patients about this common lower urinary tract symptom.     

The prevalence of fecal incontinence and urinary incontinence in primiparous postpartum Chinese women

Objective

This study investigated the prevalence of fecal incontinence (FI) and urinary incontinence (UI) in primiparous postpartum Chinese women.

Study design

Questionnaires about FI and UI symptoms were completed via telephone interviews conducted within 6 months postpartum.

Results

A total of 1889 primiparous postpartum women were asked to participate in this investigation. Only 13 (0.69%) of them had FI within 6 months after parturition, including loss of flatus in six women (0.32%), loss of solid stool in one (0.05%), loss of liquid stool in two (0.11%) and fecal urgency in four (0.21%). Bivariate logistic regression analysis showed that FI was significantly associated with forceps delivery OR = 37.91 (95% CI 4.20-342.18, P = 0.001) and medio-lateral episiotomy OR = 11.79 (95% CI 1.47-94.46, P = 0.02). The prevalence of UI, stress urinary incontinence (SUI), urge urinary incontinence (UUI) and mixed urinary incontinence (MUI) was 9.9% (186), 8.0% (151), 1.0% (18) and 0.9% (17), respectively. Multinomial logistic regression analysis found that SUI prevalence was related to age OR = 1.08 (95% CI 1.04-1.12, P = 0.000), maternal weight OR = 1.04 (95% CI 1.02-1.06, P = 0.001), neonate head circumference OR = 1.17 (95% CI 1.01-1.36, P = 0.043), spontaneous labor OR = 5.42 (95% CI 2.60-11.32, P = 0.000), forceps delivery OR = 7.0 (95% CI 2.40-20.41, P = 0.000), and medio-lateral episiotomy OR = 5.24 (95% CI 3.15-8.72, P = 0.000).

Conclusions

1. FI and UI prevalence was lower in our department than reported in previous studies in other areas. 2. Vaginal delivery has a risk impact on women's FI and UI, especially forceps delivery and medio-lateral episiotomy. 3. Maternal age, weight, newborn head circumference, spontaneous vaginal delivery, forceps delivery, and medio-lateral episiotomy increase the risk of UI.     

The prevalence of urinary incontinence

Urinary incontinence is one of the most important health problems confronting modern society. More than 50 million men and women throughout the world are afflicted. Population studies have demonstrated that approximately 10% of all women suffer from urinary incontinence. Prevalence figures increase with increasing age and in women aged > or = 70 years more than 20% of the female population are affected. Urinary incontinence not only causes considerable personal suffering for the individual afflicted but is also of immense economic importance for the health service. The annual cost of urinary incontinence in Sweden in 1990 accounted for 2% of the total health care costs.     

Prevalence of faecal incontinence among women with urinary incontinence

Four hundred and sixty-five women attending a urodynamic clinic were interviewed, and completed a detailed bowel questionnaire, about their urinary and bowel symptoms. All the women underwent video-cystourethrography with pressure and flow studies. The reported incidence of faecal incontinence was 15.3% (   n = 71  ) on direct questioning and 26% 0(  n = 121  ) on the postal questionnaire. Faecal incontinence was more common in women with a urodynamic diagnosis of detrusor instability (30'%1 (   n = 26  )) than among women diagnosed as having genuine stress incontinence (21% (   n = 38  )). Denervation and myogenic injuries sustained during childbirth have been suggested as a common cause for genuine stress and faecal incontinence, but there may be an alternative mechanism to explain why women with detrusor instability suffer from faecal incontinence.     

Prevalence of urinary incontinence among Saudi women

ObjectiveTo estimate the prevalence of female urinary incontinence (UI) in Jeddah, Saudi Arabia; to determine associated risk factors; and to identify healthcare-seeking behavior among affected women.MethodsA cross-sectional study of women attending Ministry of Health primary healthcare centers in Jeddah, Saudi Arabia, was conducted. Participants completed a questionnaire that evaluated factors associated with UI.ResultsThe mean age of the 379 participants was 35 years and the median parity was 4. The overall prevalence of UI was 41.4% (95% CI, 36.6–46.5). Stress UI, urgency UI, and mixed UI were reported by 36.4% (95% CI, 31.7–41.4), 27.4% (95% CI, 23.2–32.1), and 22.2% (95% CI, 18.3–26.6), respectively. Urinary leakage was reported daily by 17.2%, and 25.5% experienced leakage more than once a week. Risk factors for UI included increased age (P < 0.001); parity greater than 5 (P < 0.001); menopause (P = 0.004); and history of vaginal gynecologic surgery, chronic cough, or constipation (P ≤ 0.001). Medical advice was not sought by 85.5% of women with UI. Many of the women with UI reported adverse effects on their daily activities.ConclusionFemale UI is prevalent in Saudi Arabia; however, the majority of women with this condition did not seek medical advice.     

Laparoscopic two-team slings for women with stress urinary incontinence

STUDY OBJECTIVE: To review long-term success and complication rates of laparoscopic two-team sling procedures in women with stress urinary incontinence or mixed incontinence confirmed by urodynamic testing and cystoscopy. DESIGN: Prospective study (Canadian Task Force classification II-2). SETTING: Tertiary urogynecology unit at a university-affiliated teaching hospital. PATIENTS: One hundred seventy-five women. INTERVENTIONS: Laparoscopic two-team sling procedure. MEASUREMENTS AND MAIN RESULTS: The extraperitoneal approach to the space of Retzius was accomplished using a balloon device, and the intraperitoneal approach involved a transverse incision through the anterior parietal peritoneum 6 cm above the symphysis. A 1.5- to 2.0-cm wide strip of polypropylene mesh was inserted through a vertical incision along the anterior vaginal wall, perforating the urogenital diaphragm under laparoscopic guidance. The mesh was sutured to Cooper's ligaments bilaterally with 0 polypropylene sutures. Mean operating time was 80.1 +/- 30.0 minutes, mean estimated blood loss was 160 +/- 146 ml, and mean hospital stay was 2.4 +/- 1.2 days. Patients were followed at 6 weeks, 6 months, 1 year, and yearly (mean 17.8 mo, range 1-5 yrs). CONCLUSION: Laparoscopic two-team sling procedures can be performed safely in women with recurrent stress incontinence and those with risk factors for failure of retropubic urethropexy. Long-term success rates are excellent (91.1%) with few complications.     

Surgical treatment of stress urinary incontinence in women

Stress urinary incontinence is a common problem with 13.6% of women requiring surgery for it in their lifetime. Surgical treatments either create suburethral support or augment urethral closure. Colposuspensions and autologous rectus fascial slings are effective first-line surgical options. The use of midurethral tapes is currently suspended due to concerns with chronic pelvic and vaginal pain.     

Pharmacological treatment of women awaiting surgery for stress urinary incontinence

OBJECTIVE: Duloxetine, a serotonin/norepinephrine reuptake inhibitor, has been effective in the treatment of mild and moderate stress urinary incontinence. The aim of this trial was to assess its efficacy for women with severe stress urinary incontinence. METHODS: One hundred nine women, aged 33-75 years, enrolled into this double-blind, randomized, placebo-controlled study. Subjects had to have a predominant symptom of stress urinary incontinence with an incontinence episode frequency 14 per week or more, pure urodynamic stress urinary incontinence, and continence surgery already scheduled. Women were randomized to placebo (n = 54) or duloxetine 80 mg/d (n = 55) for 4 weeks, escalated to 120 mg/d for 4 weeks. Assessment variables included incontinence episode frequency, continence pad use, the Incontinence Quality of Life (I-QOL) questionnaire, and the Willingness to Consider Surgery rating. A responder was defined as a subject with an incontinence episode frequency reduction of 50% or more. RESULTS: There were significant improvements with duloxetine compared with placebo in incontinence episode frequency (-60% versus -27%, P <.001), I-QOL score (+10.6 versus +2.4, P =.003), and pad use (-34.5% versus -4.8%, P =.008). At the conclusion of the 8-week study, 10/49 (20%) duloxetine-treated women were no longer interested in surgery, compared with 0/45 placebo-treated women (P =.001). Duloxetine-treated subjects were significantly more likely to be classified as responders (relative risk 4.68, 95% confidence interval 2.27-9.66). The number of subjects-needed-to-treat to gain an additional incontinence episode frequency responder with duloxetine was 2.02. All duloxetine responses were observed within 2 weeks. Side effects and discontinuations because of side effects were significantly more common with duloxetine. CONCLUSION: The data support duloxetine's efficacy in women with severe stress urinary incontinence and suggest that some women responding to duloxetine may reconsider their willingness to undergo surgery.     

Surgical treatment of stress urinary incontinence in women

Stress urinary incontinence is a common problem with 13.6% of women requiring surgery for it in their lifetime. Surgical treatments either create suburethral support or augment urethral closure. Colposuspensions and autologous rectus fascial slings are effective first-line surgical options. The use of midurethral tapes is currently suspended due to concerns with chronic pelvic and vaginal pain.