ICIQ symptom and quality of life instruments measure clinically relevant improvements in women with stress urinary incontinence

Aims

To determine whether changes in questionnaire scores on symptoms and condition‐specific quality of life reflect clinically relevant improvements in women with stress urinary incontinence (SUI).

Methods

We retrospectively analyzed questionnaires collected during a randomized controlled trial in women with SUI, that received pelvic floor muscle training (PFMT) in two different formats. We included 218 women that answered validated self‐assessment questionnaires at baseline and at a 4‐month follow‐up. We registered changes on two questionnaires, the International Consultation on Incontinence Modular Questionnaire–Urinary Incontinence Short Form (ICIQ‐UI SF) and the Lower Urinary Tract Symptoms Quality of Life (ICIQ‐LUTSqol). We compared these score changes to responses from the Patient Global Impression of Improvement (PGI‐I) questionnaire. Differences were analyzed with the Spearman rho and one‐way‐ANOVA. The minimum important difference (MID) was the mean change in score for women that experienced a small improvement.

Results

The PGI‐I correlated significantly to both the ICIQ‐UI SF (r = 0.547, P < 0.0001) and ICIQ‐LUTSqol (r = 0.520, P < 0.0001). Thus, larger reductions in symptoms or quality of life scores were associated with greater impressions of improvement. The changes in ICIQ‐UI SF and ICIQ‐LUTSqol scores were significant across all PGI‐I groups from “no change” to “very much improved” (P < 0.05). The MIDs were 2.52 (SD 2.56) for ICIQ‐UI SF and 3.71 (SD 4.95) for ICIQ‐LUTSqol.

Conclusions

The change in ICIQ‐UI SF and ICIQ‐LUTSqol scores after PFMT reflected clinically relevant improvements in women with SUI. The MIDs established for this population may facilitate future research, treatment evaluations, and comparisons between studies. Neurourol. Urodynam. 34:747–751, 2015. © 2014 The Authors. Neurourology and Urodynamics published by Wiley Periodicals, Inc.     

Impact of clean intermittent catheterization on quality adjusted life years (QALYs) in spinal cord injury patients with neurogenic urinary incontinence

Aims

The impact of clean intermittent catheterization (CIC) on quality adjusted life years (QALYs) gained in adults’ spinal cord injury population with neurogenic urinary incontinence (UI).

Methods

Patients were recruited from the national registry January‐June 2014. The inclusion criteria were adults, neurogenic UI due to spinal cord injury (SCI), use of collection devices and CIC for more than 6 months. The exclusion criteria were inability to perform CIC, cancer of the lower urinary tract and fistulas formation. Measurement tools were the International Consultation on Incontinence Questionnaire‐Urinary Incontinence Short Form (ICIQ‐UI SF) and an estimation of life expectancy by the national registry. The calculation of the weighting factor (WF) was obtained by linear transformation of the ICIQ‐UI SF total score. A score was transformed to the range from 0 (worst impact) to 1 (no impact). The QALYs was calculated as the weighting factor × life expectancy in years.

Results

A total of 229/365 patients were involved in this study (63%). Patients before CIC reached an ICIQ mean score of 14.83, WF of 0.29, and QALYs of 9.02 during life expectancy. After 6 months of follow‐up using CIC, ICIQ reached 9.12, WF 0.57 and QALYs 17.45. The number of QALYs increased by 93.5% and UI evaluated with the ICIQ‐UI SF decreased by 38.5% (P < 0.01).

Conclusions

The CIC of the urinary bladder statistically significantly increased the number of QALYs and reduced the degree of UI in SCI patients.     

Mobile app for treatment of stress urinary incontinence: A randomized controlled trial

Aims

To evaluate the effect of a mobile app treatment for stress urinary incontinence (SUI) in women.

Methods

Randomized controlled trial, conducted 2013‐2014 in Sweden. Community‐dwelling adult women with ≥1 SUI episode/week recruited through our website and randomized to app treatment (n = 62) or control group (postponed treatment, n = 61). One participant from each group was lost to follow‐up. Intervention was the mobile app Tät^® with a treatment program focused on pelvic floor muscle training (PFMT), and information about SUI and lifestyle factors. Primary outcomes, 3 months after randomization: symptom severity (International Consultation on Incontinence Modular Questionnaire Urinary Incontinence Short Form [ICIQ‐UI SF]); and condition‐specific quality of life (ICIQ Lower Urinary Tract Symptoms Quality of Life [ICIQ‐LUTSqol]).

Results

One hundred and twenty‐three women were included (mean age 44.7), with moderate/severe SUI (97.5%, 120/123), mean ICIQ‐UI SF score 11.1 (SD 2.8) and mean ICIQ‐LUTSqol score 34.4 (SD 6.1) at baseline. At follow‐up, the app group reported improvements in symptom severity (mean ICIQ‐UI SF score reduction: 3.9, 95% confidence interval 3.0‐4.7) and condition‐specific quality of life (mean ICIQ‐LUTSqol score reduction: 4.8, 3.4‐6.2) and the groups were significantly different (mean ICIQ‐UI SF score difference: ?3.2, ?4.3to ?2.1; mean ICIQ‐LUTSqol score difference: ?4.6, ?7.8 to ?1.4). In the app group, 98.4% (60/61) performed PFMT at follow‐up, and 41.0% (25/61) performed it daily.

Conclusions

The mobile app treatment was effective for women with SUI and yielded clinically relevant improvements. This app may increase access to first‐line treatment and adherence to PFMT.

     

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.     

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.     

Pelvic floor training improves faecal incontinence and obstructed defaecation despite the presence of rectal intussusception

Background

Rectal intussusception is often observed in patients with faecal incontinence and obstructed defaecation. The aim of this study is to assess if pelvic floor training improves faecal incontinence and obstructed defaecation in patients with rectal intussusception.

Methods

Case notes of all patients referred to Bankstown Hospital Pelvic Floor Clinic between 2013 and 2018 for the management of faecal incontinence and obstructed defaecation and rectal intussusception were retrospectively reviewed using a prospectively maintained database. St Mark's faecal incontinence and Cleveland clinic constipation scores were obtained from patients before and after they underwent pelvic floor training.

Results

One hundred and thirty-one patients underwent pelvic floor training at Bankstown Hospital Pelvic Floor Clinic between 2013 and 2018. Sixty-one patients had rectal intussusception (22 low-grade and 39 high-grade). Median St Marks score improved following pelvic floor training from 8 to 1 (P < 0.001). Median Cleveland Clinic constipation score improved from 8 to 5 (P < 0.001). In patients with low grade rectal intussusception, pelvic floor training improved median St Mark's score from 3 to 0 (P = 0.003), whereas Cleveland Clinic constipation score improved from 9 to 7 (P < 0.001). In patients with high-grade rectal intussusception, pelvic floor training improved median St Mark's score from 9 to 2 (P < 0.001), whereas median Cleveland Clinic constipation score improved from 8 to 4 (P < 0.001).

Conclusion

Pelvic floor training without biofeedback therapy improves faecal incontinence and obstructed defaecation. Improvement in symptoms is unrelated to rectal intussusception observed on proctography or at examination under anaesthesia in these patients.     

Results of a prospective,multicenter study evaluating quality of life,safety, and efficacy of sacral neuromodulation at twelve months in subjects with symptoms of overactive bladder

Aims

This prospective, multicenter post‐approval study evaluated the success rate of sacral neuromodulation (SNM) with the InterStim® System at 12‐months. Subjects with bothersome symptoms of overactive bladder (OAB) including urinary urge incontinence (UI) or urgency‐frequency (UF), who failed at least one anticholinergic medication and had at least one not tried were included.

Methods

Subjects with successful test stimulation received an SNM implant. Therapeutic success (≥50% improvement in average leaks/day or voids/day or a return to normal voiding frequency [<8 voids/day]) and quality of life through 12 months were evaluated for implanted subjects.

Results

Of the 340 subjects that went through test stimulation, 272 were implanted with SNM. Of these, 91% were female, mean age was 57, UI subjects had 3.1 ± 2.7 leaks/day, UF subjects had 12.6 ± 4.5 voids/day. The analysis which includes all implanted subjects with diary data at baseline and 12 months showed an OAB therapeutic success rate of 85% at 12 months. UI subjects had a mean reduction of 2.2 ± 2.7 leaks/day; UF subjects had a mean reduction of 5.1 ± 4.1 voids/day (both P < 0.0001). Subjects showed significant improvement from baseline in all measures of ICIQ‐OABqol (all P < 0.0001). 80% of subjects reported improved changes in their urinary symptom interference at 12 months. Device‐related adverse events occurred in 16% (56/340) of subjects during test stimulation and 30% (82/272) of subjects post‐implant.

Conclusions

This multicenter study shows SNM is safe and effective and results in improved outcomes through 12 months in subjects with OAB symptoms, without requiring failure of all medications. Neurourol. Urodynam. 35:246–251, 2016. © 2014 The Authors. Neurourology and Urodynamics published by Wiley Periodicals, Inc.     

Urinary incontinence and hydration: A population‐based analysis

Aims

To determine if there is an association between urinary incontinence (UI) and an objective measure of hydration status in men and women in a nationwide, population‐based sample.

Methods

We utilized data from the 2009 to 2010 and 2011 to 2012 National Health and Nutrition Examination Surveys (NHANES), cross sectional surveys of the US non‐institutionalized population. Our primary outcome was moderate/severe UI measured using a validated scale. Our exposure of interest was hydration status. Urine osmolality ≥ 800 mOsm/kg defined dehydration versus adequate hydration (<800 mOsm/kg). We included men and women ≥ 20 years who had both UI and urine osmolality data. Using multivariable models, we controlled for age, race/ethnicity, BMI, chronic kidney disease, the interaction of age with osmolality, and hysterectomy (women only).

Results

Among the 11 482 total subjects, 9497 (83%—4882 men and 4615 women) had both UI and urine osmolality data. Compared to women, men were less likely to report UI (5.9% vs 18.9%; P < 0.001) and more likely to be dehydrated (33.4% vs 24.0%; P < 0.001). In bivariate analysis, men and women who were dehydrated had less UI than men with adequate hydration (men: 3.5% vs 7.6%; P < 0.001; women: 16.3% vs 20.0%; P = 0.02); however, dehydration was not associated with UI in men (OR 0.2, 95% CI 0.6‐1.0) or in women (OR 0.8, 95% CI 0.4‐1.5) in multivariable models.

Conclusions

Hydration status as defined by urine osmolality was not associated with moderate to severe urinary incontinence in men or women.     

Is there an alternative to pad tests? Correlation of subjective variables of severity of urinary loss to the 1‐h pad test in women with stress urinary incontinence

OBJECTIVE

To compare the 1‐h pad test in women who have urodynamically confirmed stress incontinence (USI) with a patient‐based 3‐point symptom severity scale and validated quality of life (QoL) questionnaires.

PATIENTS AND METHODS

In all, 98 women with USI were prospectively recruited; all had a 1‐h pad test and completed the validated disease‐specific QoL questionnaires, including short forms of the International Consultation on Incontinence Questionnaire (ICIQ‐SF), Urogenital Distress Inventory (UDI‐6), and Incontinence Impact Questionnaire (IIQ‐7). In addition, the severity of incontinence was determined using the Stamey grading scale, a visual analogue scale (VAS) score, and a patient‐based 3‐point symptom severity scale.

RESULTS

The VAS, symptom severity scale, Stamey grade, UDI‐6, and IIQ‐7 failed to correlate significantly with the 1‐h pad test. Only the ICIQ‐SF correlated significantly with this test.

CONCLUSION

The ICIQ‐SF is easy to administer and, in this study, correlated best with the 1‐h pad test in women with pure primary or secondary USI. It incorporates both symptom severity and QoL variables. We recommend its routine use in clinical practice.     

A populational—based survey on the prevalence,incidence, and risk factors of urinary incontinence in older adults—results from the “SABE STUDY”

Aims

To estimate the prevalence and incidence of urinary incontinence (UI) and identify the associated risk factors in a cohort of elderly individuals in Brazil.

Methods

In 2006, individuals aged ≥60 years were selected from the SABE Study (Health, Well‐being, and Aging). The dependent variable was reported UI in 2009. UI was assessed using the International Consultation on Incontinence Questionnaire Urinary Incontinence‐Short Form (ICIQ‐UI SF). Incidence was measured in units of 1000 person‐years, and Cox regression was applied for data analysis. Multivariate analysis was used to assess risk factors for UI. Incidence risk ratio (IRR) was used for comparison.

Results

This is the first study to examine the incidence of UI in Brazilian elderly individuals. In total, 1413 individuals were included; the mean age was 74.5 years, and 864 (61.8%) participants were female. The risk of UI was greater among women with cancer (other than skin) and among those with diabetes. In men, the risk of UI was greater for those in Instrumental Activities of Daily Living (IADL) category “5‐8” and those who self‐reported a “fair” health status. The prevalence of UI was 14.2% and 28.2% for men and women, respectively. The incidence rate of UI was 25.6 and 39.3 (×1000 person‐years) for men and women, respectively.

Conclusions

The incidence rate of UI among older adults in the Brazilian community was high for elderly individuals. The identified risk factors were diabetes and IADL category 5‐8 (women) as well as cancer (other than skin) and self‐reported health status (male).     

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.     

Sacral neuromodulation: long‐term outcome and quality of life in patients with faecal incontinence

Aim Since 1994 sacral neuromodulation (SNM) has increasingly been used for the treatment of faecal incontinence, but no long‐term data in a large group of patients have so far been published. We report long‐term outcome and quality of life in the first 50 patients treated by permanent SNM for faecal incontinence. Method We began to use SNM in 2000. Data from the first 50 patients with faecal incontinence who underwent permanent SNM are presented. Efficacy was assessed using a bowel diary and the Quality of Life score was assessed by the Faecal Incontinence Quality of Life questionnaire (FIQOL) and the standard short form health survey questionnaire (SF‐36). Results Over a median follow up of 7.1 (5.6–8.7) years, forty‐two (84%) patients had an improvement in continence of over 50%. Median incontinent episodes and days of incontinence per week decreased significantly during follow up (P < 0.002). Improvement was seen in all four categories of the FIQOL scale and in some domains of the SF‐36 QOL questionnaire. There were no statistically significant changes in the median resting and squeeze anal canal pressures. Conclusion Initial improvement in continence with SNM was sustained in the majority of patients, with an overall success rate of 80% after a permanent implant at 7 years.     

Novel minimally invasive laser treatment of urinary incontinence in women

Background and Objective

Urinary incontinence (UI) is a common disorder that affects women of various ages and impacts all aspects of life. Our aim was to evaluate the non‐invasive erbium:yttrium‐aluminum‐garnet (Er:YAG) laser that exploits its thermal effect and has been used in reconstructive and rejuvenation surgery as a potential treatment strategy for stress UI (SUI) and mixed UI (MUI).

Study Design/Materials and Methods

We included 175 women (aged 49.7 ± 10 years) with newly diagnosed SUI (66% of women) and MUI (34%), respectively. Patients were clinically examined and classified by incontinence types (SUI and MUI) and grades (mild, moderate, severe, and very severe) using International Consultation on Incontinence Modular Questionnaire (ICIQ) and assessing Incontinence Severity Index (ISI). Using Er:YAG laser, we performed on average 2.5 ± 0.5 procedures in each woman separated by a 2 month period. At each session, clinical examination was performed, ICIQ and ISI assessed and treatment discomfort measured with visual analog system (VAS) pain scale, and adverse effects and patients’ satisfaction were followed. Follow‐ups were performed at 2, 6, and 12 months after the treatment.

Results

After the treatment, ISI decreased for 2.6 ± 1.0 points in patients diagnosed with mild UI before the treatment, for 3.6 ± 1.4 points in those with moderate UI, for 5.7 ± 1.8 points in those with severe UI and for 8.4 ± 2.6 in those with very severe UI (P < 0.001, paired samples t‐test). Altogether, in 77% patients diagnosed with SUI, a significant improvement was found after treatment, while only 34% of women with MUI exhibited no UI at one year follow‐up. Age did not affect the outcome. No major adverse effects were noticed in either group.

Conclusion

The results of our study, have shown that new non‐invasive Er:YAG laser could be regarded as a promising additional treatment strategy for SUI with at least one year lasting positive effects. On the other hand, it does not seem appropriate for treating MUI. Lasers Surg. Med. 47:689–697, 2015. © 2015 The Authors. Lasers in Surgery and Medicine Published by Wiley Periodicals, Inc.     

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.     

Discrepancies between patient-reported outcome measures when assessing urinary incontinence or pelvic- prolapse surgery

Introduction and hypothesis

In order to assess the outcome following surgery for urinary incontinence (UI) and pelvic organ prolapse (POP) the importance of patient-reported outcome measures, in addition to the clinical objective measures, has been recognised. The International Consultation on Incontinence has initiated the development and evaluation of disease-specific questionnaires (ICIQ) to compare the patient’s degree of improvement. Alternatively, the Patient’s Global Impression of Improvement (PGI-I score) with an inherent before–after assessment has been widely accepted in recent studies. The aim of this study was to compare the PGI-I versus the ICIQ score for women undergoing UI or POP surgery.

Methods

This study is based on self-administered pre- and postoperative questionnaires, completed by women undergoing surgery for UI or POP in Denmark in 2013. Weighted Kappa statistics and 95 % limits of agreement method were used when comparing the PGI-I and ICIQ scores.

Results

Among the 3,310 women included the PGI-I score showed a higher improvement than the IQIC score, for UI 0.83 (CI 95 %: 0.80–0.85) vs 0.62 (0.60–0.64) and for POP 0.77 (0.75–0.78) vs 0.66 (0.65–0.67).

Conclusions

The PGI-I score renders higher satisfaction than the ICIQ score and the PGI-I score overestimates the improvement following UI and POP surgery.

     

Urodynamic evaluation of sacral neuromodulation for urge urinary incontinence

OBJECTIVE

To evaluate the urodynamic data before and 6 months after implantation of sacral neuromodulation (SNM, an established treatment for voiding dysfunction, including refractory urge urinary incontinence, UI) and to assess the correlation between the urodynamic data and clinical efficacy in patients with UI.

PATIENTS AND METHODS

In all, 111 patients with a >50% reduction in UI symptoms during a percutaneous nerve evaluation test qualified for surgical implantation of SNM. Patients were categorized in two subgroups, i.e. those with UI with or without confirmed detrusor overactivity (DO) at baseline. At the 6‐month follow‐up all patients had a second urodynamic investigation, with the stimulator switched on.

RESULTS

At baseline, there was urodynamically confirmed DO in 67 patients, while 44 showed no DO. A review of filling cystometry variables showed a statistically significant improvement in bladder volumes at first sensation of filling (FSF) and at maximum fill volume (MFV) before voiding for both UI subgroups, compared with baseline. In 51% of the patients with UI and DO at baseline, the DO resolved during the follow‐up. However, those patients were no more clinically successful than those who still had DO (P = 0.73). At the 6‐month follow‐up, 55 of 84 implanted patients showed clinical benefit, having a ≥50% improvement in primary voiding diary variables. Patients with UI but no DO had a higher rate of clinical success (73%) than patients with UI and DO (61%), but the difference was not statistically significant.

CONCLUSION

These urodynamic results show a statistically significant improvement in FSF and MFV in patients with UI with or with no DO after SNM. Although there was a urodynamic and clinical improvement in both groups, patients with UI but no DO are at least as successful as patients with UI and DO. Therefore in patients with UI, DO should not be a prerequisite selection criterion for using SNM.     

Severe depression and anxiety in women with overactive bladder

Aim

Depression and anxiety are prevalent psychiatric conditions and are associated with overactive bladder. The objective of this study was to determine prevalence and severity of anxiety and depression associated with overactive bladder (OAB) in women.

Methods

274 women with clinical diagnosis of OAB were recruited from 2012 to 2015. They were submitted to the International Consultation on Incontinence Questionnaire‐Overactive Bladder (ICIQ‐OAB), the Beck Depression Inventory (BDI), and the Beck Anxiety Inventory (BAI).

Results

Severe or moderate depression was present in 59.8% of women and severe or moderate anxiety was identified in 62.4%. Higher scores of depression and anxiety were associated with higher scores of ICIQ‐OAB (P = 0.0031 and 0.0049). Women with severe depression had higher nocturia score than those with mild depression (P = 0.0046). Also, women with severe depression had higher urgency incontinence score than those with minimal depression (P = 0.0261). Patients with severe anxiety had higher nocturia score than those with minimal anxiety (P = 0.0118) and women with moderate anxiety had higher urgency incontinence score than with minimal anxiety (P = 0.0300).

Conclusions

Moderate or severe depression and anxiety are prevalent in women with OAB. There is a correlation between intensity of OAB symptoms with depression and anxiety. Anxiety and depression levels are mainly related with urgency incontinence and nocturia.     

Lower urinary tract symptoms and urinary incontinence in a geriatric cohort – a population‐based analysis

Study Type – Symptom prevalence (prospective cohort) Level of Evidence 1b What's known on the subject? and What does the study add? Prevalence and severity of urinary incontinence and lower urinary tract symptoms increase with age and have a considerable negative influence on quality of life. As a result of demographic changes the proportion of octogenarians will increase in the next decades substantially, yet the literature on urinary incontinence and lower urinary tract symptoms of the oldest old is scant. This population‐based study of 85‐year‐old subjects sheds new light on this topic.

OBJECTIVES

• ? To assess prevalence and severity of lower urinary tract function in 85‐year‐old men and women.
• ? Little is known on the prevalence of lower urinary tract dysfunction in this geriatric age group, which is now the fastest growing sector of the population worldwide.

PATIENTS AND METHODS

• ? The Vienna Trans‐Danube Aging study (VITA) is a longitudinal, population‐based study initiated in 2000 that included men/women aged 75 years living in a well‐defined area in Vienna.
• ? The main purpose of the VITA study was to identify risk factors for incident Alzheimer's disease.
• ? All study participants alive in 2010 were contacted by mail to complete a detailed questionnaire on various aspects of lower urinary tract symptoms (LUTS) and urinary incontinence (UI).

RESULTS

• ? The response rate was 68%, resulting in a total of 262 questionnaires available for analysis (men n= 96; women n= 166). All study participants were 85 years of age.
• ? Urinary incontinence defined as any involuntary loss during the past 4 weeks was reported by 24% of men and 35% of women (P= 0.04). Stress UI was more frequent in women (39%) than in men (14%, P < 0.01), the difference for urge UI (women 35%, men 25%) was on the border of statistical significance (P= 0.05). Only four individuals (1.5%) needed permanent catheterization.
• ? Urgency (women 56%, men 54%) and daytime frequency (women 70%, men 74%) were equally distributed (P > 0.05). Nocturia more often than twice was more prevalent in men (69%) than in women (49%) (P= 0.02). Overactive bladder, according to International Continence Society criteria, was present in 55% of women and 50% of men.
• ? No difference regarding quality of life impairment as the result of LUTS and UI was noticed between sexes. A few co‐morbidities were identified to correlate with UI and storage symptoms.

CONCLUSIONS

• ? These data provide insights into the prevalence and severity of LUTS and UI in individuals in their eighties, to our knowledge the largest population‐based study in this age group.
• ? Demographic changes in upcoming decades underline the importance of a thorough understanding of lower urinary tract dysfunction in a geriatric population.

     

Urinary incontinence after obstetric anal sphincter injuries (OASIS)—is there a relationship?

This study aimed to compare urinary symptoms and its impact on women’s quality of life after obstetric anal sphincter injuries (OASIS) with a matched control group in the short term. The study group consisted of 100 primiparous women with OASIS and 104 controls who sustained a second-degree tear or had a mediolateral episiotomy performed. All women completed a validated International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) questionnaire 10 weeks after delivery. Compared to controls, significantly more women with OASIS reported overall urinary incontinence (21.2 vs 38%, p = 0.005) and had significantly worse quality of life score (incontinence score: 2.42 vs 1.2; p = 0.008). Significantly more women with OASIS suffered from stress urinary incontinence (33 vs 14%; p = 0.002; OR 3.06; CI = 1.54–6.07) than controls. Logistic regression analysis revealed that OASIS and a prolonged (>50 min) second stage of labour were independent risk factors for the development of stress urinary incontinence. This study highlights the importance of inquiring about urinary incontinence in women with OASIS. Presented to the German Forum Urodynamicum 2006 by IS (11.03.2006) and received the Eugen-Rehfisch Award of the German Forum Urodynamicum.     

Urinary incontinence in persons with Prader‐Willi Syndrome

Study Type – Symptom prevalence (non‐consecutive cohort)
Level of Evidence 3b

OBJECTIVE

To assess and identify the frequency and type of urinary incontinence (UI), as well as associated symptoms in persons with Prader‐Willi syndrome (PWS). PWS is characterized by mental retardation, short stature, obesity and hypogonadism. The behavioural phenotype includes eating problems, temper outbursts, affective disorders, stereotypies and speech abnormalities. UI is common in children with mental retardation in general, but has not been reported systematically in children with PWS so far.

MATERIALS AND METHODS

The Dutch version of the ‘Parental Questionnaire: Enuresis/Urinary Incontinence’ was completed by 118 parents of children with PWS. This questionnaire includes items referring to day‐ and night‐time wetting, toilet habits, observable voiding behaviours and reactions, urinary tract infections, stool habits and behavioural symptoms.

RESULTS

The rate of nocturnal enuresis in persons with PWS was 13.6% (16) at a mean age of 15.1 years. 3.8% (5) had additional daytime urinary incontinence, and 3.3% (4) had faecal incontinence. Lower urinary tract symptoms were commonly indicative of overactive bladder, dysfunctional voiding and postponement. Also, the rate of internalizing and externalizing behavioural problems was high.

CONCLUSION

Urinary incontinence is more common in persons with PWS than in typically developing children, adolescents and adults. As lower urinary tract symptoms are common, detailed assessment and specific treatment of UI should be part of the care of all persons with PWS.