The “1-3-5 cough test”: comparing the severity of urodynamic stress incontinence with severity measures of subjective perception of stress urinary incontinence

Introduction and hypothesis

The purpose of the study was to examine whether a test performed during urodynamics, the “1-3-5 cough test”, could determine the severity of urodynamic stress incontinence (USI).

Methods

We included women referred for urodynamics who were diagnosed with USI. The “1-3-5 cough test” was performed to grade the severity of USI at the completion of filling cystometry. A diagnosis of “severe”, “moderate” or “mild” USI was given if urine leakage was observed after one, three or five consecutive coughs respectively. We examined the associations between grades of USI severity and measures of subjective perception of stress urinary incontinence (SUI): International Consultation of Incontinence Modular Questionnaire—Female Lower Urinary Tract Symptom (ICIQ-FLUTS), King’s Health Questionnaire (KHQ), Urinary Distress Inventory-6 (UDI-6), Urinary Impact Questionnaire-7 (UIQ-7).

Results

A total of 1,181 patients completed the ICIQ-FLUTS and KHQ and 612 completed the UDI-6 and UIQ-7 questionnaires. There was a statistically significant association of higher grades of USI severity with higher scores of the incontinence domain of the ICIQ-FLUTS. The scores of the UDI-6, UIQ-7 and of all KHQ domains (with the exception of general health perception and personal relationships) had statistically significant larger mean values for higher USI severity grade. Groups of higher USI severity had statistically significant associations with higher scores of most of the subjective measures of SUI.

Conclusions

Severity of USI, as defined by the “1-3-5 cough test”, was associated with the severity of subjective measures of SUI. This test may be a useful tool for the objective interpretation of patients with SUI who undergo urodynamics.

     

What is the predictive value of urodynamics to reproduce clinical findings of urinary frequency, urge urinary incontinence, and/or stress urinary incontinence?

Introduction and hypothesis  

The aim of this study was to determine the predictive value of urodynamics to reproduce clinical findings of urinary frequency (UF), urge urinary incontinence (UUI), and/or stress urinary incontinence (SUI).     

The effect of pelvic pain and urinary incontinence on women’s self-rated health in northern Mexico

Introduction and hypothesis

This study was designed to assess the effect of gynecological morbidities on Mexican women’s self-rated health status and emotional health.

Methods

A cross-sectional population-based study was conducted among Mexican women aged 25–54. We analyzed information on 1,303 participants living in Hermosillo, Mexico. Multiple logistic regression was used to assess the effect of having any one of three kinds of pelvic pain, urinary incontinence or both of these conditions on women’s self-rated health. Additionally, we conducted analysis of variance and multiple linear regression to test the effect of these gynecological morbidities on women’s self-reported emotional health.

Results

Nearly one-third (31.2%) of participants rated their health as fair to very poor. Women reporting of at least one gynecological morbidity were more likely to rate their health as fair to very poor. In adjusted analyses, in addition to older age, low educational attainment, marital status other than single, lack of access to medical care, recurrent kidney infection, asthma, diabetes, and, reporting one or concurrent gynecological morbidities were associated with increased odds (adjusted odds ratios?=?1.53–3.91) of reporting fair to very poor self-rated health. Women who did not report any gynecological morbidity had significantly lower mean scores for anxiety/fear 0.30 (±0.30) than women with two to four conditions (anxiety/fear 0.45 ±?0.31).

Conclusion

Pelvic pain, urinary incontinence, and the co-occurrence of these conditions have a negative impact on women’s perception of their health status and their emotional health.

     

Medical management of stress urinary incontinence: Is there a future?

Stress urinary incontinence (SUI) is a common problem among women worldwide. Multiple treatment modalities exist, ranging from physiotherapy to surgery. Numerous reports demonstrate mixed results for efficacy and safety of several oral agents used to treat SUI. Although there are data suggesting reasonable efficacy for several medications, surgery still remains the mainstay of treatment for most women. This article reviews the available oral agents that have been studied and assesses the data supporting their use while highlighting the limitations of each.     

Predicting the development of stress urinary incontinence 3?years after hysterectomy

Introduction and hypothesis  

We aimed to develop a prediction rule to predict the individual risk to develop stress urinary incontinence (SUI) after hysterectomy.     

Non-face-to-face treatment of stress urinary incontinence: predictors of success after 1 year

Introduction and hypothesis

The objective was to determine predictors of long-term success in women with stress urinary incontinence (SUI) treated with a 3-month pelvic floor muscle training (PFMT) program delivered via the Internet or a brochure.

Methods

We included 169 women with SUI ≥1 time/week who completed the 1-year follow-up (n?=?169, mean age 50.3, SD 10.1 years). Three outcome variables defined success after 1 year: Patient Global Impression of Improvement (PGI-I), International Consultation on Incontinence Modular Questionnaire Urinary Incontinence Short Form (ICIQ-UI SF), and sufficient treatment. Using logistic regression, we analyzed data from the baseline, and from the 4-month and 1-year follow-ups, for potential predictors of success.

Results

Of the participants, 77 % (129 out of 169) were successful in ≥1 of the outcomes, 23 % (37 out of 160) were successful in all 3. Participants with successful short-term results were more likely to succeed in the corresponding outcome at 1 year than those without successful short-term results (adjusted odds ratios [ORs]: PGI 5.15, 95 % confidence interval [CI] 2.40–11.03), ICIQ-UI SF 6.85 (95 % CI 2.83–16.58), and sufficient treatment 3.78 (95 % CI 1.58–9.08). Increasing age predicted success in PGI-I and sufficient treatment (adjusted OR 1.06, 95 % CI 1.02–1.10, and 1.08, 95 % CI, 1.03–1.13 respectively). Compared with not training regularly, regular PFMT at 1 year predicted success for PGI and sufficient treatment (adjusted OR 2.32, 95 % CI 1.04–5.20, and 2.99, 95 % CI 1.23–7.27 respectively).

Conclusion

The long-term success of a non-face-to-face treatment program for SUI with a focus on PFMT can be predicted by successful short-term results, increasing age, and the performance of regular PFMT after 1 year.

     

Why do women have stress urinary incontinence?

This article reviews progress made in understanding the causes of stress urinary incontinence. Over the last century, several hypotheses have been proposed to explain stress urinary incontinence. These theories are based on clinical observations and focus primarily on the causative role of urethral support loss and an open vesical neck. Recently these hypotheses have been tested by comparing measurements of urethral support and function in women with primary stress urinary incontinence to asymptomatic volunteers who were recruited to be similar in age, race, and parity. Maximal urethral closure pressure is the parameter that differs the most between groups being 43% lower in women with stress incontinence than similar asymptomatic women having as effect size of 1.6. Measures of urethral support effect sizes range from 0.5 to 0.6. Because any one objective measure of support may not capture the full picture of urethrovesical mobility, review of blinded ultrasounds of movements during cough were reviewed by an expert panel. The panel was able to identify women with stress incontinence correctly 57% of the time; just 7% above the 50% that would be expected by chance alone, confirming that urethrovesical mobility is not strongly associated with stress incontinence. Although operations that provide differential support to the urethra are effective, urethral support is not the predominant cause of stress incontinence. Improving our understanding of factors affecting urethral closure may lead to novel treatments targeting the urethra and improved understanding of the small but persistent failure rate of current surgery. Neurourol. Urodynam. 29:S13–S17, 2010. © 2010 Wiley‐Liss, Inc.     

Surgical preparation: are patients “ready” for stress urinary incontinence surgery?

Introduction and hypothesis

Patient preparedness for stress urinary incontinence (SUI) surgery is associated with improvements in post-operative satisfaction, symptoms and quality of life (QoL). This planned secondary analysis examined the association of patient preparedness with surgical outcomes, treatment satisfaction and quality of life.

Methods

The ValUE trial compared the effect of pre-operative urodynamic studies with a standardized office evaluation of outcomes of SUI surgery at 1 year. In addition to primary and secondary outcome measures, patient satisfaction with treatment was measured using a five-point Likert scale (very dissatisfied to very satisfied) that queried subjects to rate the treatment’s effect on overall incontinence, urge incontinence, SUI, and frequency. Preparedness for surgery was assessed using an 11-question Patient Preparedness Questionnaire (PPQ).

Results

Based on PPQ question 11, 4 out of 5 (81 %) of women reported they “agreed” or “strongly agreed” that they were prepared for surgery. Selected demographic and clinical characteristics were similar in unprepared and prepared women. Among SUI severity baseline measures, total UDI score was significantly but weakly associated with preparedness (question 11 of the PPQ; Spearman's r?=?0.13, p?=?0.001). Although preparedness for surgery was not associated with successful outcomes, it was associated with satisfaction (r _s?=?0.11, p?=?0.02) and larger PGI-S improvement (increase; p?=?0.008).

Conclusions

Approximately half (48 %) of women “strongly agreed” that they felt prepared for SUI. Women with higher pre-operative preparedness scores were more satisfied, although surgical outcomes did not differ.     

The Hordaland women’s cohort: prevalence, incidence, and remission of urinary incontinence in middle-aged women

Introduction and hypothesis

The aim of study is to prospectively investigate the prevalence, incidence, and remission of urinary incontinence (UI) in a cohort of middle-aged women.

Methods

In 1997–1999, 2,229 randomly selected women aged 41–45 agreed to participate in the Hordaland Women’s Cohort, and six almost identical postal questionnaires were sent them during the following 10 years. Response rate was 95.7% at inclusion and has remained 87% to 93% in subsequent waves; 64.1% answered all six questionnaires. UI variables include type, amount, frequency, and severity.

Results

Prevalence of UI increased by age until a peak in age group 51–52 years for any (50.3%) and significant (10.0%) UI. There was then a decrease in prevalence caused by a decrease in incidence and decrease in remission. Stress UI was the major type and most UI was of low severity.

Conclusion

Prevalence of any UI is high in middle-aged women but reaches a peak followed by a decrease.     

Does the impact of urinary incontinence on quality of life differ based on age?

Introduction and hypothesis

The purpose of this study was to evaluate if the impact of urinary incontinence (UI) on quality of life (QOL) differs between women based on age.

Methods

A retrospective review of patients presenting for the management of UI was performed. Patients with UI and their corresponding degree of bother were identified by their responses to validated questionnaires. Distributions of comorbidities and types of UI were presented as frequencies and compared between age cohorts with a chi-square test. Mean scale scores were assessed for normality and a one-way analysis of variance with a post hoc Scheffé’s test was used to compare the scores.

Results

Of 765 patients meeting inclusion criteria, 22.4 % were <45, 28.9 % were 45–55, and 48.8 % were >55 years of age. Women older than 55 were significantly more likely to have urge UI and mixed UI than their counterparts (p?<?0.001). Women <45 and 45–55 were more negatively impacted in their ability to perform physical activities compared to women >55 (p?=?0.004), whereas women >55 were significantly less likely to feel frustrated by their incontinence than women <45 (p?=?0.022). However, there was no significant difference in overall impact of incontinence among groups (p?=?0.585).

Conclusions

UI equally impacts the functional and psychological QOL in women regardless of age. UI in women <55 results in a greater negative impact on level of physical activity, whereas women <45 are significantly more frustrated.     

Contasure-needleless® compared with Monarc® for the treatment of stress urinary incontinence

Introduction and hypothesis

For the treatment of stress urinary incontinence (SUI), various retropubic and transobturator techniques have demonstrated high cure rates. Single-incision tapes, such as Contasure-Needleless® (C-NDL), have demonstrated similar cure rates to the inside-out transobturator sling (TVT-O®).The aim of this study was to analyse if C-NDL® is equally as effective as an outside-in transobturator sling (Monarc®) for the treatment of SUI.

Methods

We carried out a prospective, single-centre, randomised trial. The results were analysed for a non-inferiority test with a minimum postoperative follow-up of 12 months. The objective and subjective cure rates were evaluated by a stress test and a postoperative Sandvik Severity Index respectively. Patient satisfaction and operative complications were registered. The cure was defined by a negative stress test and SSI 0.

Results

A total of 187 patients were included, 89 and 98 undergoing C-NDL® and Monarc® respectively. Epidemiological and clinical data did not show and significant differences between both groups except a high prevalence of women who smoke (15.7% C-NDL® vs 6.1% Monarc®, p 0.03). The negative stress test was negative in 72 patients (80.9%) in C-NDL® compared with 85 (88.5%) in Monarc® (p 0.082). The SSI was 0 in 47 (66.2%) for C-NDL® and 61 (70.1%) for the Monarc® group (p 0.01). There were 14 (16.1%) and 8 (8.3%) dissatisfied patients for the C-NDL® and Monarc® groups respectively (p 0.068). The rate of complications was similar in both groups.

Conclusions

According to the non-inferiority test, C-NDL® is not inferior to Monarc® (post-surgical SSI test), but it is inferior in the comparison of a negative stress test and patient satisfaction.

     

Is anterior genital tract trauma associated with complaints of postpartum urinary incontinence?

We evaluated whether anterior genital trauma is associated with urinary incontinence after vaginal birth. A prospective cohort of midwifery patients consented to mapping of trauma at birth and assessment of continence postpartum. Trauma was categorized into intact, anterior (periuretheral, clitoral, labial), perineal or both. Incontinence was defined as a positive response to the question, “Since the birth of your baby, have you leaked urine when you did not mean to?” and social impact assessed by the Incontinence Impact Questionnaire-7 (IIQ-7). Of 554 eligible women, 436 (79%) provided incontinence data 3 months postpartum. Genital trauma was common, occurring in 80% of women: in 148 (34%) trauma was anterior, 119 (27%) had both anterior and perineal trauma and 80(18%) had only perineal trauma. Since delivery, 27% (118/436) women leaked urine. Fewer had IIQ-7 scores greater than 0, at 55/436 (12%). Women with anterior trauma, 29/148 (20%), were less likely to complain of incontinence than all others, 89/288 (31%) (P?=?0.01). Urinary incontinence is common after giving birth, although most women have mild symptoms. Anterior trauma is not associated with increased complaints of urinary incontinence.     

Post stroke urinary loss,incontinence and life satisfaction: When does post‐stroke urinary loss become incontinence?

AIMS: While urinary incontinence (UI) has been extensively studied after stroke, the threshold for when it becomes a social problem by affecting life satisfaction or social participation has not been established. The study goal was to establish this threshold, examine the impact of UI on life satisfaction and participation, and determine whether UI contributes independently to poor stroke outcome. METHODS: Retrospective analysis was performed on prospectively collected data from a cohort of consecutive admissions to the acute Neurology Stroke Service of a large metropolitan teaching hospital. Four hundred and sixty patients with ischemic stroke were prospectively evaluated for stroke severity, medical, and demographic factors. Telephone interviews were completed with 361 community-dwelling subjects 6 months after stroke onset. RESULTS: The FIM bladder item was used to determine the frequency of urinary loss. All patients were continent before stroke onset, 16% reported UL at 6-month follow-up. ROC analysis suggested that UI once per month or more is associated with diminished quality of life and activity participation. Logistic regression found poor life satisfaction associated with ADL impairment, cognitive disability, low SF12 physical and mental health scores, and incontinence. Poor outcome was independent of stroke severity. CONCLUSIONS: Urinary loss became incontinence when it occurred at least monthly. UI was associated with greater dependence in basic and instrumental ADL, decreased participation and low life satisfaction.     

Treatment of urinary incontinence in men with electrical stimulation: Is practice evidence-based?

Electrical stimulation is frequently recommended for the treatment of urinary incontinence in men. However, few randomized, controlled trials allow practitioners to evaluate the evidence base for this practice. The purpose of this article is to determine, based on a review of the literature, whether adequate evidence exists to support the use of electrical stimulation as a treatment of male urinary incontinence. Urge, stress, and overflow incontinence are evaluated separately. This review led to 3 conclusions: (1) theoretical and urodynamic evidence exists to support the use of electrical stimulation for urge incontinence, (2) conflicting evidence exists in the use of electrical stimulation for stress urinary incontinence, and (3) treatment of overflow incontinence in men has not been evaluated in a systematic way. For both stress urinary or overflow incontinence, practitioners should consider the existing research before recommending electrical stimulation as a first line of treatment. For urge incontinence, electrical stimulation may be an effective first-line treatment strategy.