Lower urinary tract and gastrointestinal dysfunction in sportswomen: a systematic review and meta-analysis of observational studies.

INTRODUCTION: The aim of this review was to assess the prevalence of gastrointestinal (GI) and lower urinary tract symptoms (LUTS) in sportswomen having high intensity training and to determine whether the type of sport might also affect LUTS and GI symptoms. EVIDENCE ACQUISITION: A systematic review of the literature was performed by searching PubMed, CINAHL, Cochrane Library and Web of Science up to November 2018. The search strategy included several keywords concerning pelvic floor disorders, urinary dysfunction, bowel dysfunction, sportswomen, and elite sports. Inclusion criteria were studies of women who performed any kind of sport with a prevalence of LUTS and/or bowel symptoms without any restriction for age, sport modality or frequency of training. Outcomes were prevalence of LUTS and GI symptoms and meta-analyses and moderator analyses to identify risk factors for the occurrence of these symptoms in female athletes. EVIDENCE SYNTHESIS: During the search, 1263 records were screened, 31 of which met the methodological criteria for qualitative analysis and 5 for meta-analysis. Sportswomen during daily activity showed a threefold higher risk to develop urinary incontinence (UI) than controls (OR 3.13; 95% CI: 2.39-4.00). No differences were found stratifying data for UI types. Cumulative prevalence rates were: 58.7% of all kinds of UI (daily life together with sport time), 32.8% at rest (during daily life out of sport time), 36.3% during sport time; 23% of stress urinary incontinence (SUI) during sport time versus 38.6% at rest; 11% of urge urinary incontinence (UUI) during sport time versus 17.8% at rest; 11.9% of mixed urinary incontinence (MUI) during sport time versus 20.7% at rest. Prevalence rates of GI symptoms before sport time were 57.6%, during sport competition 35.2% and 58.2% after competition. CONCLUSIONS: All the analyzed studies showed bias. This meta-analysis indicated that competitive sport activities represent a risk factor for urinary incontinence and gastrointestinal disorders. To prevent urinary leakage athletes should be instructed to strengthen the pelvic floor muscles.

Efficacy and safety of polydimethylsiloxane injection (Macroplastique® ) for the treatment of female stress urinary incontinence: results of a series of 85 patients with ≥3 years of follow-up.

OBJECTIVE: To assess the long-term efficacy and safety of polydimethylsiloxane injection (Macroplastique® , Cogentix Medical, Orangeburg, New York, USA) for the treatment of female stress urinary incontinence (SUI), with a minimum follow-up of 3 years. PATIENTS AND METHODS: This is an observational analytical prospective cohort study conducted in a single uro-gynaecological unit. All consecutive women with urodynamically confirmed pure SUI treated with the Macroplastique procedure, were included. Data regarding patient outcomes (International Consultation on Incontinence Questionnaire-Short Form, Patient Global Impression of Improvement, and patient satisfaction scores), objective cure rates, and adverse events were collected during follow-up. Uni- and multivariable analyses were performed to investigate outcomes. Multiple logistic regression was performed to identify factors involved in the risk of failure of the procedures or recurrence of SUI. RESULTS: In all, 85 women had the Macroplastique procedure. At the 3-year follow-up, all 85 (100%) patients were available for the evaluation. We did not find any significant change in the surgical outcomes during this time. At 3 years after surgery, 42 of 85 patients (49%) declared themselves cured (P = 0.67). Similarly, at the 3-year evaluation, 40 of 85 patients (47%) were objectively cured. There was no significant deterioration of objective cure rates over time (P = 0.3). A history of radical pelvic surgery and a low surgeon's skill were significantly associated with the risk of failure of Macroplastique. The multivariate analysis confirmed these findings; a previous history of radical pelvic surgery and a low surgeon's skill independently predicted the subjective and objective failure of Macroplastique. CONCLUSIONS: The 3-year results of this study showed that Macroplastique could be an acceptable alternative for the treatment of SUI with stable results over time and a negligible complication rate.