Urinary incontinence in female outpatients in Singapore

Introduction and hypothesis

The aims of this study were to determine the prevalence, symptom characteristics, risk factors and impact on quality of life (QoL) of urinary incontinence (UI) in female outpatients in Singapore, to describe the attitudes of these women towards UI, and to investigate the barriers to healthcare-seeking behaviour in symptomatic women.

Methods

This was a cross-sectional study in a convenience sample and 249 women enrolled from outpatient clinics. A modified self-administered questionnaire which included two validated instruments (the International Consultation on Incontinence Questionnaire-Urinary Incontinence short form and the Incontinence Impact Questionnaire-7) was used.

Results

Questionnaires from 230 women were included in the analysis. The overall prevalence of UI was 41.74% (95% CI 35.49–48.26%). Most of the symptomatic women suffered from mild UI and the most common subtype was stress UI. Age (OR 1.03, 95% CI 1.00–1.05), vaginal delivery (OR 2.67, 95% CI 1.43–4.97) and being sexually active (OR 2.41, 95% CI 1.31–4.43) were associated with UI. Among symptomatic women, only 41.25% (95% CI 30.82–52.53%) had sought medical attention before. The most common barrier to healthcare-seeking behaviour was embarrassment. The median QoL score was 33.33, indicating a mild impact of UI on QoL. QoL score was associated with UI severity (p < 0.001).

Conclusions

Despite the high prevalence of UI, only about 41% of UI sufferers had sought medical attention before. Common barriers included embarrassment, fear of surgery and misconceptions. This study emphasizes the need for policy development for UI prevention and management in Singapore.

     

Treatment of Abdominal Aortic Aneurysm in Nine Countries 2005–2009: A Vascunet Report

Objectives

To study contemporary treatment and outcome of abdominal aortic aneurysm (AAA) repair in nine countries.

Design and methods

Data on primary AAA repairs 2005–2009 were amalgamated from national and regional vascular registries in Australia, Denmark, Finland, Hungary, Italy, Norway, Sweden, Switzerland and the UK. Primary outcome was in-hospital or 30-day mortality. Multivariate logistic regression was used to assess case-mix.

Results

31,427 intact AAA repairs were identified, mean age 72.6 years (95% CI 72.5–72.7). The rate of octogenarians and use of endovascular repair (EVAR) increased over time (p < 0.001). EVAR varied between countries from 14.7% (Finland) to 56.0% (Australia). Overall perioperative mortality after intact AAA repair was 2.8% (2.6–3.0) and was stable over time. The perioperative mortality rate varied from 1.6% (1.3–1.8) in Italy to 4.1% (2.4–7.0) in Finland. Increasing age, open repair and presence of comorbidities were associated with outcome.7040 ruptured AAA repairs were identified, mean age 73.8 (73.6–74.0). The overall perioperative mortality was 31.6% (30.6–32.8), and decreased over time (p = 0.004).

Conclusions

The rate of AAA repair in octogenarians as well as EVAR increased over time. Perioperative outcome after intact AAA repair was stable over time, but improved after ruptured repair. Geographical differences in treatment of AAA remain.     

Risk factors for urinary incontinence among postmenopausal Mexican women

Introduction and hypothesis

Previous studies of racial/ethnic variation in urinary incontinence (UI) suggest that population-specific studies of UI risk factors are needed to develop appropriate public health recommendations. We assessed UI risk factors among postmenopausal Mexican women enrolled in the Mexican Teachers’ Cohort.

Methods

We conducted a cross-sectional study among 15,296 postmenopausal women who completed the 2008 questionnaire. UI cases were women who reported experiencing UI during menopause. Self-reported potential UI risk factors included age, reproductive variables, smoking status, adiposity, and several health conditions. We estimated multivariate-adjusted odds ratios (ORs) and 95 % confidence intervals (CIs) for UI using multivariable logistic regression.

Results

Among these postmenopausal women, the prevalence of UI was 14 %. Odds of UI were higher among women with ≥4 children vs nulliparous women (OR 1.43, 95 % CI 1.04–1.96) or body mass index (BMI) ≥30 vs <22 kg/m² (OR 2.00, 95 % CI: 1.55–2.57). Age at first birth <20 vs 20–24 years, past or current vs never smoking, larger waist-to-hip ratio, and history of asthma, high blood pressure, or diabetes were also associated with higher odds of UI (OR 1.2–1.3). We found a trend of lower odds of UI with older age.

Conclusions

Our data suggest that information about UI and UI prevention strategies might be particularly useful for Mexican postmenopausal women with 4 or more children or higher BMI. Further studies with longitudinal UI data, in addition to data on UI severity and subtype, are needed to provide more specific information about UI risk factors to Mexican women.

     

Factors associated with urinary incontinence in middle-aged women: a population-based household survey

Introduction and hypothesis

The objective was to determine the prevalence of urinary incontinence (UI) and factors associated in a sample of Brazilian middle-aged women.

Methods

A cross-sectional study was conducted between September 2012 and June 2013 with 749 women. UI was defined as any complaint of involuntary loss of urine. The independent variables were sociodemographic data and health-related habits and problems. Statistical analysis was carried out using Chi-squared test and Poisson regression.

Results

The mean age was 52.5 (±4.4) years. The prevalence of UI was 23.6 %. Of these, 48 (6.4 %) had stress urinary incontinence, 59 (7.8 %) urinary urgency, and 70 (9.5 %) had mixed urinary incontinence. In the final statistical model, self-perception of health as fair/poor/very poor (PR: 1.90; 95 % CI, 1.45–2.49; P?<?0.001), ≥1 vaginal deliveries (PR: 1.84; 95 % CI, 1.35–2.50; P?<?0.001), higher body mass index (PR: 1.04; 95 % CI, 1.02–1.06; P?=?0.001), vaginal dryness (PR: 1.60; 95 % CI, 1.23–2.08; P?=?0.001), current or previous hormone therapy (PR: 1.38; 95 % CI, 1.06–1.81; P?=?0.019), pre-/perimenopause (PR: 1.42; 95 % CI, 1.06–1.91; P?=?0.021), and previous hysterectomy (PR: 1.41; 95 % CI, 1.03–1.92; P?=?0.031) were associated with a greater prevalence of UI. Current or previous use of soy products to treat menopausal symptoms was associated with a lower prevalence of UI (PR: 0.43; 95 % CI, 0.24–0.78; P?=?0.006).

Conclusions

Several factors are associated with UI in middle-aged Brazilian women. The results highlight the importance of carrying out interventions aimed at reducing modifiable factors.

     

Elective Endovascular vs. Open Repair for Abdominal Aortic Aneurysm in Patients Aged 80 Years and Older: Systematic Review and Meta-Analysis

Objectives

Endovascular treatment (EVAR) of abdominal aortic aneurysm (AAA) is thought to be of benefit, particularly in patients aged ≥80 years. This issue was investigated in the present meta-analysis.

Design

The study design involved a systematic review of the literature and meta-analysis.

Methods

Systematic review of the literature and meta-analysis of data on elective EVAR vs. open repair of AAA in patients aged ≥80 years were performed.

Results

Six observational studies reporting on 13 419 patients were included in the present analysis. Pooled analysis showed higher immediate postoperative mortality after open repair compared with EVAR (risk ratio 3.87, 95% confidence interval (CI) 3.19–4.68; risk difference, 6.2%, 95%CI 5.4–7.0%). The pooled immediate mortality rate after open repair was 8.6%, whereas it was 2.3% after EVAR. Open repair was associated with a significantly higher risk of postoperative cardiac, pulmonary and renal complications. Pooled analysis of three studies showed similar overall survival at 3 years after EVAR and open repair (risk ratio 1.10, 95%CI 0.77–1.57).

Conclusions

The results of this meta-analysis suggest that elective EVAR in patients aged ≥80 years is associated with significantly lower immediate postoperative mortality and morbidity than open repair and should be considered the treatment of choice in these fragile patients. These results indicate also that, when EVAR is not feasible, open repair can be performed with acceptable immediate and late survival in patients at high risk of aneurysm rupture.     

Insulin-like Growth Factor I – A Novel Biomarker of Abdominal Aortic Aneurysms

Objective

The study aimed to test the potential role of insulin-like growth factor I (IGF-I) and IGF-II as biomarkers for abdominal aortic aneurysm (AAA).

Methods and results

IGF-I and II levels were analysed in 115 patients with screening diagnosed AAA kept under annual surveillance for 10 years.Serum IGF-I correlated positively with AAA size and growth rate (r = 0.23, P = 0.016 and r = 0.27, P = 0.004), persisting after adjustment for potential confounders.Serum IGF-I level predicted cases needing later surgery (AOC: 0.63; 95% confidence interval: 0.52–0.73).

Conclusions

In this prospective, long-term study, baseline serum IGF-I correlated positively with AAA size and growth rate and predicted future need for preventive surgery.     

The Cost of Failure: Assessing the Cost-Effectiveness of Rescuing Patients from Major Complications After Liver Resection Using the National Inpatient Sample

Objective

To estimate the cost of rescue and cost of failure and determine cost-effectiveness of rescue from major complications at high-volume (HV) and low-volume (LV) centers

Methods

Ninety-six thousand one hundred seven patients undergoing liver resection were identified from the Nationwide Inpatient Sample (NIS) between 2002 and 2011. The incremental cost of rescue and cost of FTR were calculated. Using propensity-matched cohorts, a cost-effectiveness analysis was performed to determine the incremental cost-effectiveness ratio (ICER) between HV and LV hospitals.

Results

Ninety-six thousand one hundred seven patients were identified in NIS. The overall mortality was 2.3% and was lowest in HV centers (HV 1.4% vs. MV 2.1% vs. LV 2.6%; p?<?0.001). Major complications occurred in 14.9% of hepatectomies and were comparable regardless of volume (HV 14.2% vs. MV 14.3% vs. LV 15.4%; p?<?0.001). The FTR rate was substantially lower among HV centers (HV 7.7%, MV 11%, LV 12%; p?<?0.001). At a willingness to pay benchmark of $50,000 per year of life saved, both HV (ICER?=?$3296) and MV (ICER?=?$4182) centers were cost-effective at rescuing patients from a major complication compared to LV hospitals.

Conclusion

Not only was FTR less common at HV hospitals, but the management of most major complications was cost-effective at higher volume centers.

     

Decreasing prevalence of abdominal aortic aneurysm and changes in cardiovascular risk factors

Objective

A significant reduction in the incidence of cardiovascular disease, including abdominal aortic aneurysm (AAA), has been observed in the past decades. In this study, a small but geographically well defined and carefully characterized population, previously screened for AAA and risk factors, was re-examined 11 years later. The aim was to study the reduction of AAA prevalence and associated factors.

Urinary Incontinence in French Women: Prevalence,Risk Factors,and Impact on Quality of Life

Background

The lack of epidemiologic data on the prevalence of female urinary incontinence (UI) attending general practitioners (GPs) in France led us to conduct a cross-sectional study in our country.

Objectives

To determine the prevalence of UI and to assess its impact on the quality of life (QoL).

Design, setting, and participants

This cross-sectional study of women aged >18 yr was conducted by attending GPs between June 2007 and July 2007.

Measurements

The main outcome measures were urinary symptoms, functional impairment, International Consultation on Incontinence Questionnaire–Short Form score, and medical care seeking.

Results and limitations

Overall, 241 GPs enrolled 2183 women seen during 1 d. The prevalence of UI was 26.8% (n = 584) and increased with age, body mass index (BMI), and number of children delivered (p < 0.0001). Among women with UI, 496 were included in a cross-sectional survey: 45.2% (n = 224) had stress UI, 42.1% (n = 209) had mixed UI, and 10.9% (n = 53) had urge UI, while 2% (n = 10) had UI of indeterminate type. Overall, 288 of 496 women (51.8%) stated that UI had a negative impact on their QoL; this effect remained mostly mild or moderate, and only 197 of 496 women (39.7%) had asked for medical help. Longer duration of symptoms, higher frequency of comorbid urinary symptoms, and altered QoL were most frequent among women with mixed UI (p < 0.001). Misclassification may have occurred because the diagnosis of UI was based on self-reported data rather than on clinical or urodynamic examinations.

Conclusions

UI symptoms were found in almost one in four women attending GPs. Clinical and functional UI impairment were associated with age, BMI, and parity. UI caused distress to women, but only those who were severely affected sought help. The results emphasize the need for policy development for UI prevention and management in France.     

Urinary Incontinence,Overactive Bladder,and Other Lower Urinary Tract Symptoms: A Longitudinal Population-Based Survey in Men Aged 45–103 Years

Background

Lower urinary tract symptoms (LUTS) such as urinary incontinence (UI) and overactive bladder (OAB) are highly prevalent conditions, but there are few studies describing progression and remission of LUTS in men, especially over the long term.

Objective

To describe the prevalence of UI, OAB, and LUTS using current International Continence Society definitions in the same men studied longitudinally over time.

Design

Prospective, population-based, longitudinal study.

Setting and participants

In 1992, 10 458 men aged 45–99 yr, resident in the city of Gothenburg, were selected at random from the Population Register.

Measurements

The men received a postal questionnaire about the presence of LUTS, as well as questions on social, medical, health-related quality of life (HRQoL), and demographic data. Responders in 1992 were reassessed 11 yr later in 2003 using a similar questionnaire.

Results and limitations

In 2003, 4072 of the 7763 men who responded in 1992 were still available in the Population Register and 3257 men (80%) aged 56–103 yr, responded. Prevalence of UI and OAB had increased (p < 0.01) in the same men assessed in 1992 (4.5% and 15.6%, respectively) and 2003 (10.5% and 44.4%, respectively). The prevalence of nocturia, urgency, slow stream, hesitancy, incomplete emptying, postmicturition dribble, and the number of daytime micturitions had also increased (p < 0.01). Only a minority reported regression of symptoms. Men with UI or OAB reported a poorer (p < 0.001) HRQoL compared with men without UI or OAB.

Conclusions

There was a marked increase in the prevalence of UI, OAB, and other LUTS in the same men assessed longitudinally over this 11-yr period. UI and OAB had a negative influence on HRQoL, and men who developed UI or OAB had a greater deterioration in HRQoL than men who had no change in their UI/OAB status over time.     

The National Health Service Abdominal Aortic Aneurysm Screening Programme in England

Background

Ruptured abdominal aortic aneurysm (AAA) is responsible for the premature death of more than 4,000 men in England and Wales every year. AAAs are usually asymptomatic before they rupture, yet they are easily detected by a simple abdominal ultrasound scan.

Methods

This paper reviews the evidence for, and implementation of, a national AAA population screening programme in England.

Results

Population screening of 65-year-old men can reassure most that they will not get an AAA, but it can also detect a small number of men with a large AAA at immediate risk of rupture, and a larger number of men with a small or medium AAA at minimal immediate risk, but who may be offered ongoing ultrasound surveillance. Population screening of men aged 65–74 has a sound evidence base, and reduces subsequent AAA-related mortality for at least 13 years by up to 50?%. Some Western countries, including the UK, have adopted population screening using public funding, whereas others remain to be convinced, and continue to collate research. The epidemiology of AAA is changing quickly, with the prevalence in 65-year-old men decreasing rapidly as smoking habits change and more medical treatments are used to manage cardiovascular risk factors.

Conclusion

As evidence on the natural history of AAA continues to emerge, new and ongoing programmes will need to be responsive and adapt. The AAA screening programme of the future will evolve using emerging clinical and cost-effectiveness data.     

Prevalence of abdominal aortic aneurysms in over 65-year-old men with inguinal hernias

INTRODUCTION

The aim of this study was to determine the prevalence of abdominal aortic aneurysms (AAAs) in over 65-year-old men who have inguinal hernias and discuss if pre-operative selective screening of this population is appropriate.

PATIENTS AND METHODS

A prospective study on 70 consecutive male patients with an age range of 65–88 years (mean, 74 years) who were referred to a single vascular consultant''s out-patient clinic with an inguinal hernia were screened for the presence of an AAA with an ultrasound scan before hernia repair over a period of 3 years.

RESULTS

Two patients were found to have an AAA measuring 3.8 cm and 6.0 cm giving an AAA prevalence of 3% (exact 95% confidence interval = 0–10%).

CONCLUSIONS

This study does not demonstrate an increased AAA prevalence in over 65-year-old male patients with inguinal hernias, scanned pre-operatively when compared to screening programmes. Selective screening of this cohort cannot be justified on this evidence.     

Measuring abdominal aortic diameters in routine abdominal computed tomography scans and implications for abdominal aortic aneurysm screening

Objective

This study aimed to determine the prevalence and relevance of incidental abdominal aortic aneurysm (AAA) on routine abdominal computed tomography (CT) and to audit the performance of radiologists to identify and report AAA.

Prevalence of symptomatic hip and knee osteoarthritis: a two-phase population-based survey

Objective

Osteoarthritis (OA) epidemiologic data are scarce in Europe. To estimate the prevalence of symptomatic knee and hip OA in a multiregional sample in France.

Design

A two-phase population-based survey was conducted in six regions in 2007–2009. On initial phone contact using random-digit dialing, subjects 40–75 years old were screened with a validated questionnaire. Subjects screened positive were invited for ascertainment: physical examination and hip and/or knee radiography (Kellgren–Lawrence grade ≥ 2). Multiple imputation for data missing not-at-random was used to account for refusals.

Results

Of 63,232 homes contacted, 27,632 were eligible, 9621 subjects screened positive, 3707 participated fully in the ascertainment phase, and 1010 had symptomatic OA: 317 hip, 756 knee. Hip OA prevalence according to age class ranged from 0.9% to 3.9% for men and 0.7–5.1% for women. Knee OA ranged from 2.1% to 10.1% for men and 1.6–14.9% for women. Both differed by geographical region. The hip and knee standardized prevalence was 1.9% and 4.7% for men and 2.5% and 6.6% for women, respectively.

Conclusions

This confirmed the feasibility of using a screening questionnaire for eliciting population-based estimates of OA. In France, it increases with age and is greater among women above the age of 50. The geographical disparity of hip and knee OA parallels the distribution of obesity.Study registration ID number 906297 at http://www.clinicaltrials.gov/.     

The Impact of Gender on Prognosis After Non-cardiac Vascular Surgery

Objectives

The objective was to evaluate the impact of gender on long-term survival of patients who underwent non-cardiac vascular surgery.

Design, Material and Methods

Our prospectively collected data contained information on 560 patients undergoing carotid endarterectomy (CEA), 923 elective abdominal aortic aneurysm repairs (AAA) and 1046 lower limb reconstructions (LLR). Patient characteristics and long-term mortality of women were compared to that of men. Kaplan–Meier (KM) survival curves were constructed for men and women, on which we superimposed age- and sex-matched KM survival curves of the general population. Cox proportional hazards regression was used to identify risk factors for mortality.

Results

Men in the CEA group had statistically significant higher all-cause mortality, hazard rate ratio (HRR) 1.41 (95% CI 1.01–1.98) No differences in mortality between the genders were observed in the AAA and LLR groups.Overall, men had more co-morbidities but received more disease-specific medication compared to women. Women retained their higher life expectancy after CEA but lost it in the AAA and LLR groups.

Conclusion

Women retain their higher life expectancy after CEA; however, after AAA repair and LLR, this advantage is lost. Both men and women received too little disease-specific medication, but women were worse off.     

Abdominal aortic aneurysm in patients affected by intermittent claudication: prevalence and clinical predictors

Background

Abdominal aortic aneurysm (AAA) is a frequent cause of death among elderly. Patients affected by lower extremity peripheral arterial disease (LE-PAD) seem to be particularly at high risk for AAA. We aimed this study at assessing the prevalence and the clinical predictors of the presence of AAA in a homogeneous cohort of LE-PAD patients affected by intermittent claudication.

Methods

We performed an abdominal ultrasound in 213 consecutive patients with documented LE-PAD (ankle/brachial index ≤0.90) attending our outpatient clinic for intermittent claudication. For each patient we registered cardiovascular risk factors and comorbidities, and measured neutrophil count.

Results

The ultrasound was inconclusive in 3 patients (1.4%), thus 210 patients (169 males, 41 females, mean age 65.9 ± 9.8 yr) entered the study. Overall, AAA was present in 19 patients (9.0%), with a not significant higher prevalence in men than in women (10.1% vs 4.9%, p = 0.300). Patients with AAA were older (71.2 ± 7.0 vs 65.4 ± 9.9 years, p = 0.015), were more likely to have hypertension (94.7% vs 71.2%, p = 0.027), and greater neutrophil count (5.5 [4.5 – 6.2] vs 4.1 [3.2 – 5.5] x10³/μL, p = 0.010). Importantly, the c-statistic for neutrophil count (0.73, 95% CI 0.60 – 0.86, p =0.010) was higher than that for age (0.67, CI 0.56–0.78, p = 0.017). The prevalence of AAA in claudicant patients with a neutrophil count ≥ 5.1 x10³/μL (cut-off identified at ROC analysis) was as high as 29.0%.

Conclusions

Prevalence of AAA in claudicant patients is much higher than that reported in the general population. Ultrasound screening should be considered in these patients, especially in those with an elevated neutrophil count.

     

Evaluation of the prevalence,type, severity,and risk factors of urinary incontinence and its impact on quality of life among women in Turkey

Introduction and hypothesis

Our purpose was to determine prevalence, type, and risk factors of urinary incontinence (UI) and their impacts on quality of life (QoL) of women in Turkey.

Methods

This cross-sectional study was performed on 150 women aged 18–80 years at the Yildirim Beyazit University Hospital’s Gynecology Outpatient Clinic in Turkey between May 2013 and September 2013. Data were collected using an individual information form and an incontinence QoL questionnaire (I-QOL). Following data distribution, we used the Mann–Whitney U test, Bonferroni-corrected Kruskal–Walis H test, logistic regression analysis, Fisher’s exact test, and the chi-square test.

Results

Mean age of the study population was 48.7?±?14.3 years and UI prevalence 86.7 %. The distribution of UI types was 37.7 % stress incontinence (SUI), 3.1 % urge (UUI), and 59.2 % mixed (MUI). I-QOL general average was 56.7?±?23.28 (min 22, max 110). Most women had experienced UI for at least 5 continuous years and reported a negative impact on QoL; 43.2 % of incontinence women had not received medical therapy. Postmenopause, uterine prolapsus, episiotomy, use of hormone replacement therapy (HRT), smoking, caffeine intake, family history of UI, macrosomia, and multiparity were risk factors for UI (p?<?0.05).

Conclusion

In this study, the prevalence of UI in women was substantial, and UI had a significantly negative impact on all aspects of QoL. However, these women had not sought medical help for the problem. Therefore, health professionals should query women of all ages about symptoms of this prevalent condition and offer treatment if it is detected.

     

Multiparity,age and overweight/obesity as risk factors for urinary incontinence in pregnancy: a systematic review and meta-analysis

Introduction and Hypothesis

Multiparity, age and high body mass index (BMI) are the most widely investigated factors associated with urinary incontinence (UI) during pregnancy. We hypothesized that multiparity, age 35 years or older and high BMI (prepregnancy and during pregnancy) are risk factors for the occurrence of UI in pregnant women.

Methods

Searches were done on MEDLINE/PubMed (1966–2017), LILACS/BIREME (1982–2017), CINAHL/Ebsco (1981–2017) and Scopus/Elsevier (1950–2017). The following criteria were used for study eligibility: (1) population: low-risk pregnant women in any trimester and without age restriction; (2) exposure factors: multiparity (≥ 2 deliveries), age 35 years or older and high BMI (overweight and obesity); (3) outcome: UI during pregnancy; (4) study design: cohort, case-control or cross-sectional studies that used multivariate logistic analysis. Two independent reviewers performed the entire systematic review process. Data extraction of each article was done and, when possible, included in a meta-analysis. Risk of study bias was assessed by NOS and quality of evidence by GRADE. A significance level of p?≤?0.05 was adopted. The PROSPERO registration number was CRD42014013193.

Results

Of 1176 articles identified through searches, 13 were included after screening and application of eligibility criteria. Very low quality of evidence shows that multiparity (OR?=?2.09; 95% CI: 1.07 to 4.08), age 35 years or older (OR?=?1.53; 95% CI: 1.45 to 1.62) and overweight and obesity during pregnancy (OR?=?1.53; 95% CI: 1.28 to 1.83) are risk factors for UI in pregnancy.

Conclusions

The exposure factors investigated are risk factors for UI in pregnancy based on a very low quality of evidence.