Changing prevalence and knowledge of urinary incontinence among Hong Kong Chinese women

A territory-wide telephone survey was conducted in Hong Kong to assess the prevalence, knowledge, and treatment-seeking behaviour of Chinese women with urinary incontinence, using validated Chinese version of Urogenital Distress Inventory (UDI-6) and Incontinence Impact Questionnaire (IIQ-7). Women, 540, aged between 17 to 77 years were interviewed. Of the respondents, 40.8% reported stress urinary incontinence, 20.4% had urge incontinence and 15.9% had mixed incontinence. Among these, 16.0% reported quality of life impairment; 9.3% felt frustrated with low morale, and 15.2% had nervous and anxiety problems. However, as many as 78.3% of the respondents did not know that stress urinary incontinence is a disease entity, and 60.6% thought that leakage of urine was a normal aging process. For those respondents having stress urinary incontinence, the first treatment of choice was physiotherapy. The second choice was medication, and surgical treatment was the last option. Respondents with stress urinary incontinence showed higher education level.     

洛阳市青少年女性尿失禁患病情况的流行病学调查

目的：调查洛阳市青少年女性尿失禁患病情况及其对生活质量的影响和患者对该病的认知和求治情况。方法：采用女性尿失禁症状问卷调查,对洛阳市初中、高中、大学在校女生整层随机抽样调查,由调查对象自己填写无记名式问卷。结果：发出问卷1800份,回收1776份,回收率98．67%,获得有效问卷1793份。初中、高中、大学女生尿失禁患病率分别为20．45%、10．44%、16．72%,总患病率为15．93%,其中SUI、UUI、MUI分别为10．18%、1．67%、4．08%,其构成比为63．90%、10．47%、25．63%。从总的调查来看,尿失禁与年龄和体重指数有关。46．05%的患者认为尿失禁是自然现象,33．35%不知该怎么办,8．55%很痛苦;仅8．19%因病就诊,91．81%未就诊,其中经济原因未就诊者占6．67%,准备就诊5．26%。就诊方向依次为妇产科医生、泌尿外科医生、长辈、其他和药店。结论：洛阳市青少年女性尿失禁患病率为15．93%。青少年女性尿失禁较高的患病率应引起高度重视,应加强对尿失禁的卫生宣传教育和治疗。     

女性尿道括约肌控尿和压力性尿失禁发病的机制

女性尿道括约肌控尿机制和压力性尿失禁发病机理的研究经历了长期和曲折的过程,目前认为,女性尿道括约肌是由尿道横纹肌括约肌、尿道平滑肌括约肌和尿道固有膜等结构,共同参与组成的一个构造精细而有序的尿道括约肌复合体或称尿道括约肌系统.压力性尿失禁的发生主要与尿道括约肌本身解剖结构和功能缺陷,以及尿道周围附属结构和支撑结构缺陷有关.     

人工尿道括约肌治疗真性尿失禁

目的：探讨人工尿道括约肌治疗真性尿失禁的效果和安全性。方法：对1例前列腺电切术后尿失禁患者进行AMS800人工尿道括约肌植入治疗。记录植入术前术后的排尿日记，并观察不良反应。结果：施行人工尿道括约肌植入术后6周开通人工尿道括约肌，尿失禁得到良好地控制，恢复自主排尿，未发生并发症，无其他不良反应，结论：人工尿道括约肌植入术是一种安全有效的治疗真性尿失禁的方法。     

The artificial urinary sphincter in the treatment of incontinence in the female patient

Technical developments have led to a reliable artificial urinary sphincter prosthesis for female patients with otherwise intractable urinary incontinence. Candidates include patients with post-operative stressincontinence or congenital or acquired neuropathic dysfunction. Proper patient selection requires extensive urologic examinations in order to guarantee a high success rate. The most serious complications are due to cuff erosion or infection. With proper operative techniques continence rate is now about 90% in female patients. A new application of the sphincter prosthesis is seen in reconstructive procedures of the lower urinary tract, often with the use of intestinal segments. Careful follow up is warranted in patients with an artificial sphincter since the upper urinary tracts must be monitored and bladder function controlled.     

Difference in quality of life in women with urge urinary incontinence compared to women with stress urinary incontinence

Introduction  We evaluated whether women with urge urinary incontinence (UUI) have lower quality of life (QOL) than women with other forms of urinary incontinence. Methods  Patients completed three validated questionnaires when presenting for evaluation at a urogynecology practice and were divided into four groups based on their responses: those with symptoms of stress urinary incontinence (SUI), UUI, both SUI and UUI (mixed UI), and neither SUI nor UUI (controls). Results  A total of 465 women were included: 53 women with UUI (11.4%), 101 with SUI (21.7%), 200 with mixed UI (43%), and 111 controls (23.9%). Overall, there was a significant difference (p < 0.001) in PFIQ bladder scale scores as a function of UI group, with individual mean PFIQ scores of 17.1 for controls, 22.3 for SUI, 32.7 for UUI, and 36.8 for mixed UI. Individually, all seven questions in the PFIQ bladder domain were significantly different by group (p ≤ 0.001). Conclusions  Women with UUI and mixed UI have lower QOL scores than women without incontinence or with only SUI. The project was approved by the IRB at Hartford Hospital.     

Coital urinary incontinence: impact on quality of life as measured by the King’s Health Questionnaire

The aim of this present study was to measure the impact of coital urinary incontinence (UI) on sexually active women quality of life (QoL). Epidemiological, observational, cross-sectional, and multicenter study including 633 sexually active women seeking treatment for UI and/or overactive bladder in a gynecological clinic, aged between 24 and 83 years. All women filled out the King’s Health Questionnaire—KHQ. With this questionnaire, we had a complete register of the different urinary symptoms, included coital UI, and the extent of how they affect patient’s life and the measurement of impact on the patient’s QoL by the KHQ score. Prevalence of coital incontinence in sexually active women was 36.2%, classifying this impact as low (59.8%), moderate (32.3%), and high (7.9%). Women reporting coital incontinence had similar mean age and body mass index (BMI) to those women without coital incontinence. Women with coital incontinence had higher scores (worse QoL) in all the dimensions and in the KHQ global score (p < 0.05). Coital incontinence was the only variable showing an independent relation to KHQ global score (B = 10.1; 95% confidence interval = 1.7–18.6) in a multiple regression model adjusted to age, BMI, and the other urinary symptoms under study. One third of the sexually active women with urinary symptoms had coital incontinence. Among sexually active women with urinary symptoms, patients with coital urinary incontinence had a higher impact on their QoL than those without coital incontinence. Coital incontinence is independently related to a KHQ high score, which suggest worse QoL.     

The prevalence of urinary incontinence in women in four European countries

OBJECTIVE: To determine the prevalence, type and treatment behaviour of women with urinary incontinence in four European countries. SUBJECTS AND METHODS: Data were collected using a postal survey which was sent to 29,500 community-dwelling women aged > or = 18 years in France, Germany, Spain and the UK. Subjects were asked about the type of urinary incontinence they had experienced and their treatment behaviour. RESULTS: Of the women who responded, 35% reported involuntary loss of urine in the preceding 30 days; stress urinary incontinence was the most prevalent type. The lowest prevalence was in Spain (23%), while the prevalence was 44%, 41% and 42% for France, Germany and the UK, respectively. About a quarter of women with urinary incontinence in Spain (24%) and the UK (25%) had consulted a doctor about it; in France (33%) and Germany (40%) the percentages were higher. Overall, <5% of the women had ever undergone surgery for their condition. While pads were used by half of the women, there were some differences among the countries. CONCLUSIONS: Millions of women in Europe have urinary incontinence; the consultation and treatment rates were low in the European countries included in this study.     

女性尿失禁患者尿动力学检查的意义

对６８例女性尿失禁的临床诊断和尿动力学检查结果进行了比较研究。根据病史、主诉、体查和辅助检查而做出的诊断，各型尿失禁之间有１５．０％到２７．８％与尿动力学检查不一致。详细的病史、体检、辅助检查与尿动力学检查结果相结合，才能对尿失禁做出正确的诊断。尿动力学检查对于拟手术的患者或基于临床诊断治疗失败的患者具有重要意义。     

The prevalence of urinary incontinence in a randomized population of 5247 adult finnish women

A randomized study of the prevalence of urinary incontinence was performed among adult Finnish females. In 1986, 5247 women (aged 25–55 years) who participated voluntarily in a gynecological health study, anonymously completed a questionnaire concerning subjective symptoms and experiences with urinary incontinence. One-fifth of the studied population (20.1%) reported that they were handicapped by incontinence. The number of incontinent women increased significantly with increasing age up to 45 years. Stress urinary incontinence alone was reported by 73% of the women experiencing incontinence. Surprisingly, only one-third of the women stated that they needed treatment, and less than one-fifth of all had sought help for this disorder.     

Increasing costs of urinary incontinence among female Medicare beneficiaries

PURPOSE: We measured the financial burden of urinary incontinence in the United States from 1992 to 1998 among women 65 years old or older. MATERIALS AND METHODS: We analyzed Medicare claims for 1992, 1995 and 1998 and estimated spending on the treatment of urinary incontinence. Total costs were stratified by type of service (inpatient, outpatient and emergency department). RESULTS: Costs of urinary incontinence among older women nearly doubled between 1992 and 1998 in nominal dollars, from $128 million to $234 million, primarily due to increases in physician office visits and ambulatory surgery. The cost of inpatient services increased only slightly during the period. The increase in total spending was due almost exclusively to the increase in the number of women treated for incontinence. After adjusting for inflation, per capita treatment costs decreased about 15% during the study. CONCLUSIONS: This shift from inpatient to outpatient care likely reflects the general shift of surgical procedures to the outpatient setting, as well as the advent of new minimally invasive incontinence procedures. In addition, increased awareness of incontinence and the marketing of new drugs for its treatment, specifically anticholinergic medication for overactive bladder symptoms, may have increased the number of office visits. While claims based Medicare expenditures are substantial, they do not include the costs of pads or medications and, therefore, underestimate the true financial burden of incontinence on the aging community.     

Electrovesicogram in stress urinary incontinence: A preliminary study

Electrovesicograms (EVG) were studied in 20 women with stress urinary incontinence (SUI) and 12 healthy female volunteers with a mean age of 44.8 and 48.2 years, respectively. Recordings were performed by means of three electrodes applied to the skin in the hypogastric area and one reference electrode to the lower limb. In the 12 healthy women pacesetter potentials (PPs) were recorded as regular triphasic waves. Of the 20 SUI patients 16 showed normal EVG, and the remaining 4 exhibited tachyvesica, i.e. increased PP frequency. These 4 patients proved to have combined urge and stress incontinence with detrusor hyperreflexia. It was concluded that SUI patients have normal EVG unless there is an associated pathology.EDITORIAL COMMENT: Genuine stress urinary incontinence (SUI) can be associated with detrusor instability, which results in urgency and urge incontinence. The results of SUI surgery are poor if this is not detected preoperatively. The electrovesicogram may be a useful new study replacing urodynamic studies to detect detrusor instability. However, the present study is too small to come to this conclusion. It is recommended that the study be continued to include a large number of patients, with comparison of results to CMG, before a conclusion can be reached.     

TVT-Abbrevo术治疗女性压力性尿失禁的疗效观察

目的:探讨TVT-Abbrevo术治疗女性压力性尿失禁的疗效及并发症。方法:2012年11月~2014年2月采用TVT-Abbrevo术治疗女性压力性尿失禁患者共52例,以术后患者主观症状的改善与否作为疗效的判断标准,观察患者的临床疗效及手术相关并发症。结果:手术时间为15~25min,平均(18.7±8.2)min;术中出血量为5~25ml,平均(13.6±4.9)ml。1例术中出现血尿,经膀胱镜检查发现膀胱颈损伤,经阴道予以修补。无尿道、神经损伤,无尿潴留发生。随访3~16个月,平均12.8个月,治愈46例(88.4%),改善3例(5.8%),无效2例(3.8%),有效率达96.2%。最大尿流率(Qmax)为(18.16±6.21)ml/s。腹股沟处疼痛(Vas疼痛评分):手术当天0分9例,0~3分43例;术后第1天0分12例,0~3分40例;术后第2天0分21例,0~3分31例;术后第3天0分41例,0~3分11例;术后2周0分49例,0~3分3例;术后1个月0分52例。术后无耻骨后血肿、吊带侵蚀、排尿困难及感染等相关手术并发症。结论:TVT-Abbrevo术治疗女性压力性尿失禁是安全、有效的,且术后腹股沟疼痛发生率和疼痛程度轻。     

人工尿道括约肌治疗尿失禁(附四例报告)

目的　探讨人工尿道括约肌治疗真性尿失禁的效果和安全性。　方法　采用美国AMS公司 80 0型人工尿道括约肌植入治疗 4例真性尿失禁患者 ,记录手术前后的排尿日记 ,尿动力学测定 ,观察其不良反应。　结果　 4例患者人工尿道括约肌植入术后 4～ 6周开通人工尿道括约肌 ,尿失禁得到良好控制 ,恢复自主排尿 ,未出现因感染而取出装置的严重并发症 ;随访 17～ 4 6个月 ,白天或夜间均无漏尿 ,无需尿垫 ,能自主排尿 ,生活质量评分平均 1分。尿动力学测定膀胱顺应性及稳定性良好 ,最大尿道闭合压 8.2～ 9.4kPa ,平均 8.7kPa ,3例无剩余尿 ,1例有少量剩余尿 ,仅 1例曾因机械故障更换控制泵。　结论　人工尿道括约肌植入术治疗真性尿失禁疗效满意 ,手术简单 ,安全可靠 ,无严重并发症。     

Psychological investigation in female patients suffering from urinary incontinence

The available data about the hypothesis that psychological conditions cause urinary incontinence are contradictory. This study was based on a group of patients undergoing urodynamic investigation to define the type of incontinence. Patients were submitted to a battery of psychological tests, including STAXI, CES-D and IBQ (in their Italian version). Patients suffering from urge incontinence showed higher degrees of inner anger and anger trait than those suffering from stress or mixed incontinence. Neither group showed signs of depression. The conviction of illness was greatest in patients suffering from stress or mixed incontinence, whereas irritability and general hypochondria prevailed in patients suffering from urge incontinence. Such patients tend to develop psychosomatic reactions that may contribute to the severity of their symptoms.Editorial Comment: Understanding a patient's perception of their incontinence and ability to cope with symptoms is an important aspect of a clinician's ability to educate the patient and treat their incontinence successfully. This is particularly true when using behavioral therapies, where the patient's understanding of the cause of their incontinence and their own volitional control of the lower urinary tract directly affects success. The investigators find that patients with DI experience more internally driven rage, which is poorly expressed, and a higher incidence of irritability and hypochondria than patients with GSI or mixed incontinence. This overall increased inner frustration may stand in the way of learning to deal with and overcome uncontrolled activity. It behooves the clinician to address this frustration in a compassionate and caring yet direct manner to maximize the patient's compliance to therapy, thus improving their chance of regaining bladder control.     

A study of quality of life in primigravidae with urinary incontinence

This study aimed to establish the prevalence and effect of urinary incontinence on quality of life during pregnancy and after parturition. A prospective cohort of primigravidae was recruited. The Kings Health Questionnaire (KHQ) was self-administered antenatally (34 weeks to term) and postnatally (3 months after delivery). Four hundred ninety-two primigravidae were recruited. The prevalence of urinary incontinence was reported as: pre-pregnancy 3.5% (17/492), antenatal 35.6% (175/492), 3–5 days postpartum 13.7% (51/370) and 3 months postnatal 13.0% (47/362). Most women with urinary incontinence experienced an impact on quality of life antenatally (54.3%) and postnatally (71.1%), although those experiencing an impact usually reported it as a little (75.8 and 87.5%). There was a higher prevalence of urinary incontinence after forceps delivery (p<0.05) but not of greater impairment in quality of life (p>0.05). Personal and general health deteriorated postnatally (p<0.05). During pregnancy most women with urinary incontinence experience minimal impact on quality of life. Postnatally, other causes of morbidity may contribute to worsening of general and personal health.Editorial Comment: This is a prospective cohort study that establishes the prevalence and effect of urinary incontinence on quality of life during pregnancy and after parturition in primigravid women. It covers new ground in its assessment of the effect on quality of life of urinary incontinence in this group of previously undescribed women. This research lays the foundation for further research into the combined effect of urinary incontinence and other co morbidities on the quality of life of pregnant women and recent parturients     

漏尿点压力测定诊断压力性尿失禁(附19例报告)

目的　进一步明确漏尿点压力（ＬＰＰ） 测定对女性压力性尿失禁（ＳＵＩ） 的诊断意义。　方法　对１９ 例女性ＳＵＩ进行详细的尿动力学检查及统一方法的ＬＰＰ 测定。将测定结果与其它检测结果进行对比分析。　结果　１９ 例病人中Ⅲ型ＳＵＩ６ 例,其ＬＰＰ 均＜ ６０ｃｍ Ｈ２Ｏ（１ｃｍ Ｈ２Ｏ＝ ０ ．０９８ｋＰａ） ;Ⅱ／ Ⅲ型４ 例,３ 例ＬＰＰ６０ ～９０ｃｍ Ｈ２Ｏ;Ⅱ型３ 例,ＬＰＰ９０ ～１２０ｃｍ Ｈ２Ｏ;Ⅰ型６ 例,５ 例ＬＰＰ＞１２０ｃｍ Ｈ２Ｏ。　结论　ＬＰＰ 测定对ＳＵＩ患者能够进行比较正确的诊断和分型,方法简单,有一定的临床应用价值     

The treatment of urinary incontinence in 1814

 A selection from a little-known medical treatise of the early 19th century is presented which describes the condition of urinary stress incontinence and its treatment by means of pessaries, mechanical occlusive devices and electrical stimulation therapy. The author provides a foreshadowing of therapies that would come into more common use 150 years later. Received: 19 June 2002 / Accepted: 21 July 2002     

Questionnaire survey on female urinary frequency and incontinence

BACKGROUND: Urinary incontinence is a well-known bothersome symptom in women, which may cause physical and psychological problems. We conducted a questionnaire survey on female urinary incontinence to investigate the disease's impact on the quality of life (QoL), the reasons women don't seek medical attention and the information they wished to obtain. PATIENTS AND METHODS: From March to October 2002, a member of the Professional Women's Coalition for Sexuality and Health distributed a questionnaire about urinary frequency and urinary incontinence to women who were attending the lectures hosted by the group. RESULTS: We analysed 262 questionnaires: 158 people belonged to the Stress Urinary Incontinence (SUI) Group, 36 to the Overactive Bladder (OAB) Group, 22 to the Urinary Frequency (UF) Group and 18 to the Normal Group. 'Going out' was most influenced in all three groups with symptoms in their daily life. Compared with the Normal or SUI Group, the QoL in those belonging to the OAB and UF Groups was more deteriorated. The medical institution check-up rate in the SUI Group was the lowest at 7.1%, bringing down the overall consultation rate to 13.5%. More than 70% of respondents who didn't have a check-up said that they did not think it was a problem serious enough to require consultation. CONCLUSIONS: Urinary incontinence and frequency impairs women's QoL. It is important to provide information on these diseases and to provide medical treatments that cater to the needs of individual patients.     

The management of adult urinary incontinence

Urinary incontinence is very common in adults, either as stress, urge or mixed urinary incontinence. A thorough assessment is necessary to identify the underlying urological abnormality and to guide appropriate management. Conservative approaches consist of treating constipation, the use of containment devices, weight loss, bladder training and pelvic floor muscle training. Medical management frequently consists of the use of antimuscarinics and more recently newer agents such as mirabegron. Surgical management is considered if previous therapies fail. Urodynamic assessment and subsequent multidisciplinary team review is commonly undertaken prior to invasive therapy. Surgical options include slings, bulking agents, botulinum toxin A, neuromodulation, artificial urinary sphincter and augmentation cystoplasty. All these options are discussed in this article, including indications, outcomes and side-effects. Areas for future development are also highlighted, with particular emphasis placed on the increasing number of males with urinary incontinence following radical prostate surgery. For all patients, a stepwise approach is recommended, beginning with the least invasive options before moving onto more complex surgery with higher risk of severe complications. Patients with refractory urinary incontinence should be considered for entry into clinical trials where novel therapies are being assessed.