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Ob-Gyn AND Urinary incontinence in elderly [keywords]
- The iceberg of health care utilization in women with urinary incontinence. [Journal Article, Research Support, N.I.H., Extramural]
- Int Urogynecol J 2012 Aug; 23(8):1087-93.
The objective of the study was to estimate prevalence of urinary incontinence (UI) health care utilization in women from the population up to specialty care.The General Longitudinal Overactive Bladder Evaluation-UI (GLOBE-UI) is a population-based study on the natural history of UI in women ≥ 40 years of age. Prevalence of UI was estimated by using the Bladder Health Survey (BHS). Survey data were linked with electronic health records to build the different steps of the iceberg of disease. Descriptive statistics were used to estimate the prevalence estimates at all levels of the iceberg.A total sample of 7,059 women received the BHS. Of those, 3,316 (47 %) responded. Prevalence of UI was 1,366 (41 %). Women with or without UI did not differ by age or marital status. However, women with versus without UI were more parous (91 vs 87 %), significantly more overweight or obese (74 vs 61 %), and more likely to have a college education or higher (54 vs 46 %), P < 0.01. Nine hundred fifty-eight (73 %) women with UI reported duration of more than 2 years and 72 % reported moderate to severe UI symptoms. Of all 1,366 women with BHS UI diagnosis, only 339 (25 %) sought care, 313 (23 %) received some care, and 164 (12 %) received subspecialty care.UI is a highly prevalent disease. Only a minority with UI appears to seek care and a fraction sees a pelvic floor specialist. It is important not only to educate women, but also primary care providers about this highly prevalent yet treatable condition.
- Comparison of the cough stress test and 24-h pad test in the assessment of stress urinary incontinence. [Comparative Study, Journal Article]
- Int Urogynecol J 2012 Apr; 23(4):429-33.
The 24-h pad test and cough stress test are commonly used to assess stress urinary incontinence; however, no comparative data are available. The cough stress test is superior to the 24-h pad test.Women with predominant stress urinary incontinence symptoms underwent a cough stress test, a 24-h pad test, and urodynamic testing.Complete data were available on 55 women. Agreement between the urodynamic results and the stress test occurred in 89% of women (k = 0.51). Sensitivity, specificity, and positive and negative predictive values were 90%, 80%, 98%, and 44%. Agreement between the urodynamic results and the pad test occurred in 60% of women (k = 0.08). Sensitivity, specificity, and positive and negative predictive values were 60%, 60%, 94%, and 13%. Agreement between the cough stress test and the pad test occurred in 67% (k = 0.26).The cough stress test is more reliable than the pad test for documentation of stress urinary incontinence.
- Risk factors for urinary tract infection following incontinence surgery. [Journal Article, Randomized Controlled Trial, Research Support, N.I.H., Extramural]
- Int Urogynecol J 2011 Oct; 22(10):1255-65.
The purpose of this study is to describe risk factors for post-operative urinary tract infection (UTI) the first year after stress urinary incontinence surgery.Multivariable logistic regression analyses were performed on data from 1,252 women randomized in two surgical trials, Stress Incontinence Surgical Treatment Efficacy trial (SISTEr) and Trial Of Mid-Urethral Slings (TOMUS).Baseline recurrent UTI (rUTI; ≥3 in 12 months) increased the risk of UTI in the first 6 weeks in both study populations, as did sling procedure and self-catheterization in SISTEr, and bladder perforation in TOMUS. Baseline rUTI, UTI in the first 6 weeks, and PVR > 100 cc at 12 months were independent risk factors for UTI between 6 weeks and 12 months in the SISTEr population. Few (2.3-2.4%) had post-operative rUTI, precluding multivariable analysis. In women with pre-operative rUTI, successful surgery (negative cough stress test) at 1 year did not appear to decrease the risk of persistent rUTI.Pre-operative rUTI is the strongest risk factor for post-operative UTI.
- Post void dribbling: incidence and risk factors. [Journal Article]
- Neurourol Urodyn 2010 Mar; 29(3):432-6.
The primary aim of this study was to determine the incidence of post void dribbling (PVD) in women being evaluated for pelvic floor dysfunction. The secondary aim was to identify other conditions present in women with symptoms of PVD.163 consecutive women with complaints of PVD who underwent urodynamic testing were studied. Testing was performed to evaluate women scheduled for surgery for incontinence, irritative bladder, urinary retention and pelvic organ prolapse. Subjects completed a medical history and voiding diary. A complete pelvic exam was performed. Patients were questioned regarding symptoms of PVD, stress incontinence, urge incontinence and insensible urine loss. Menopausal status, hormone replacement therapy status, age, body mass index, residual urine volume, genital hiatus length, and evidence of pelvic organ prolapse were recorded. Maximal urethral closure pressure, urethral length, pressure transmission ratio, and documentation of detrusor overactivity or urodynamic stress incontinence were determined by urodynamic testing.42% of patients had symptoms of PVD. The incidence of PVD decreased with age. In pre- and peri-menopausal women, there was an association between PVD and urge incontinence. In post-menopausal women, there was an association between age, body mass index, and genital hiatus length.There was a significant correlation between PVD and urge incontinence in pre-menopausal patients. The overall incidence and causes of PVD relative to age require further study. Body mass index and genital hiatus length may play an important role in PVD, especially in post-menopausal women.
- Infracoccygeal sacropexy improves the quality of life of women with uterine prolapse. [Journal Article]
- Maturitas 2008 Feb 20; 59(2):158-62.
This study evaluated the quality of life following infracoccygeal sacropexy in patients with pelvic organ prolapse by using the short versions of the Pelvic Floor Distress Inventory (PFDI-20) and the Pelvic Floor Impact Questionnaire (PFIQ-7).We prospectively studied 35 women who underwent infracoccygeal sacropexy for the management of uterine or stump prolapse. The recurrence of pelvic organ prolapse was assessed 6 months after surgery. The prolapse, urinary, and colorectal scales of PFDI-20 and PFIQ-7 were assessed at baseline and 6 months after surgery.The preoperative grade of prolapse was 2.7+/-0.7; 6 months after the surgery, it decreased to 0.4+/-0.6. PFDI-20 and its 3 respective scales demonstrated statistically significant improvements following the surgery (P<0.05). (POPDI-6 score, 57.7+/-12.3 vs. 41.6+/-8.3; CRADI-8 score, 36.6+/-7.2 vs. 28.5+/-3.2; and UDI-6 score, 57.1+/-14.8 vs. 33.9+/-7.6; preoperatively vs. postoperatively) The three scales of PFIQ-7, namely, UIQ-7, CRAIQ-7, and POPIQ-7, exhibited statistically significant improvements after the surgery (UIQ-7 score, 22.3+/-5.6 vs. 9.8+/-3.8; CRAIQ-7 score, 11.1+/-4.2 vs. 28.8+/-7.1; and POPIQ-7 score, 38.7+/-12.5 vs. 16.9+/-7.8; preoperatively vs. postoperatively).Infracoccygeal sacropexy was an effective method for the management of uterine/stump prolapse; further, it improved the quality of life of women with pelvic organ prolapse.
- Urodynamic changes after tension-free sling procedures: Mycromesh-Plus vs TVT sling. [Comparative Study, Journal Article]
- Int Urogynecol J Pelvic Floor Dysfunct 2008 Feb; 19(2):217-25.
Assortments of suburethral sling procedures have become increasingly important in the treatment of stress urinary incontinence (SUI). This study compared a consecutive series of patients undergoing two types of no-tension, midurethral sling procedures: a traditional pubovaginal technique and graft (modified polytetrafluoroethylene graft; Mycromesh-Plus [MMP]) and the more recently introduced tension-free vaginal tape (TVT) sling. We observed for differences in success rates, urodynamic parameters, and complications of the two procedures. One group received a MMP sling, which was placed at the midurethra without tension. The other group underwent a minimally invasive TVT sling. Multichannel urodynamic studies were performed pre- and postoperatively. Cure rates for SUI were similar for the two groups (95 vs 95%). Urgency and urge incontinence symptoms improved substantially in both groups. Comparison of pre- and postoperative urodynamic indices demonstrated no differences in changes in average functional urethral lengths, changes in maximum urethral closure pressures, or improvement in pressure transmission ratios. Both groups showed a decrease in urethral mobility postoperatively. However, the TVT group demonstrated a lesser degree of change. While the TVT group did spontaneously void earlier than the MMP group (5.7 vs 9.7 days, p < 0.05), this did not result in significantly different postvoid residual volumes (71 vs 101 mL). Complications, including need for self-catheterization and sling revision or removal, and urinary tract infections also were fewer in the TVT group. This study demonstrated that the TVT sling affords an equivalent cure of SUI with similar urodynamic changes but significantly fewer complications than the more traditional MMP sling.
- Translabial ultrasound assessment of the anal sphincter complex: normal measurements of the internal and external anal sphincters at the proximal, mid-, and distal levels. [Evaluation Studies, Journal Article, Research Support, N.I.H., Extramural]
- Int Urogynecol J Pelvic Floor Dysfunct 2007 Aug; 18(8):881-8.
The purpose of this study was to measure the internal and external anal sphincters using translabial ultrasound (TLU) at the proximal, mid, and distal levels of the anal sphincter complex. The human review committee approval was obtained and all women gave written informed consent. Sixty women presenting for gynecologic ultrasound for symptoms other than pelvic organ prolapse or urinary or anal incontinence underwent TLU. Thirty-six (60%) were asymptomatic and intact, 13 symptomatic and intact, and 11 disrupted. Anterior-posterior diameters of the internal anal sphincter at all levels and the external anal sphincter at the distal level were measured in four quadrants. Mean sphincter measurements are given for symptomatic and asymptomatic intact women and are comparable to previously reported endoanal MRI and ultrasound measurements.
- Prospective randomized comparison of transobturator suburethral sling (Monarc) vs suprapubic arc (Sparc) sling procedures for female urodynamic stress incontinence. [Comparative Study, Journal Article, Randomized Controlled Trial]
- Int Urogynecol J Pelvic Floor Dysfunct 2006 Sep; 17(5):439-43.
The aims of this trial were to compare the attendant complications and postoperative voiding function of the Monarc and suprapubic arc (Sparc) suburethral sling procedures. This is the first article in English literature to compare different suburethral sling procedures using prosthesis of the same material and the same weave. Sixty women with urodynamic stress incontinence alone or combined with pelvic prolapse less than International Continence Society stage II were randomly allocated to either the Monarc or Sparc group. A comparison of the peri- and postoperative results comprising complications and symptoms of voiding function revealed no significant differences between the two groups in a follow-up ranged from 6 to 14 months (median, 9 months). However, the nonsignificant increase in tendency of inadvertent vaginal perforation and disability/pain of thigh (Monarc 12.9 vs Sparc 0.0%, p=0.112 and Monarc 12.9 vs Sparc 0.0%, p=0.112, respectively) has clinical significance. Based on the analyses of the comparison of Blaivas obstruction nomograms, postoperative voiding function was not significantly different between the two surgical groups. We concluded that Monarc and Sparc suburethral taping proved to be equally safe and posed no remarkable impact on voiding function in a short term postoperative follow up. However, intraoperative urethrocystoscopy is recommended for safety in both the Monarc and Sparc procedures.
- Female urinary incontinence: what the epidemiologic data tell us. [Journal Article, Review]
- Int J Fertil Womens Med 2005 Jan-Feb; 50(1):12-7.
The prevalence of urinary incontinence (UI) in women has been the subject of many epidemiologic studies. Since 1968 the field has accumulated sufficient data that we now know how stress UI and urge UI appear in populations categorized by race, age, parity, body mass index and other demographic factors. The first comprehensive study in the U.S., the MESA study, was done in 1983. For community-dwelling women 60 years or older, it came up with the now familiar figure of 38% in this age-group. Very similar figures have been found in other national populations, but there are great differences in sub-populations and also by type--stress, urge, or mixed UI. However, with all differences in prevalence acknowledged, no type of UI is unusual in a population of older women. This article delineates, with detailed discussion of individual studies, prevalence by type, age, race, obstetric and gynecologic-surgery history, and anatomic dysfunction, plus consideration of the effects of obesity and menopause on UI. The conclusion is that a problem so widespread is a candidate for prevention, and that the few trials in this direction should be augmented.
- Incidence of urinary incontinence in postmenopausal women treated with raloxifene or estrogen. [Journal Article, Research Support, Non-U.S. Gov't]
- Menopause 2005 Mar; 12(2):160-4.
Determine the effect of raloxifene or estrogen, as compared with placebo, on the reporting of urinary incontinence in postmenopausal women participating in an osteoporosis prevention trial.The current analysis is based on adverse event data that were collected as part of a double-blind, randomized, placebo-controlled trial designed to assess the efficacy and safety of raloxifene for osteoporosis prevention in postmenopausal women. Women were 40 to 60 years of age at study entry and had a prior hysterectomy. A total of 619 women were randomized to placebo, raloxifene 60 or 150 mg/d, or conjugated equine estrogen 0.625 mg/d and followed for up to 3 years. Urinary incontinence was self-reported and rated by participants as "mild," "moderate," or "severe."The prevalence of urinary incontinence as reported by patients at baseline was similar across treatment groups (3% to 6%, P = 0.46). During 3 years of follow-up, new or worsening urinary incontinence was reported with the following frequency: placebo (1.3%), raloxifene 60 mg/d (0.7%), raloxifene 150 mg/d (0.6%), and conjugated equine estrogen (7.0%). The percentage of estrogen subjects reporting urinary incontinence was significantly greater than that for placebo and both doses of raloxifene (P < or = 0.02).During 3 years of follow-up, conjugated equine estrogen was associated with an increased incidence of reports of urinary incontinence in women with a prior hysterectomy and this was significantly greater than both placebo and raloxifene.