Validity and reliability of the Persian version of the PRAFAB questionnaire in Iranian women with urinary incontinence.

INTRODUCTION AND HYPOTHESIS: Urinary incontinence (UI) is a common disorder in women that can affect a person's quality of life. There are several instruments to assess the severity of urinary incontinence. One of the common tools is the Protection, Amount, Frequency, Adjustment, Body image (PRAFAB) questionnaire. Therefore, this study was performed with the aim of assessing the validity and reliability of the Persian version of the PRAFAB questionnaire. METHODS: First, the English version of the questionnaire was translated into Persian. Second, the psychometric properties of the Persian version were collected in 60 women with urinary incontinence referred to Al-Zahra Hospital by an expert team. Content validity (CV) was evaluated through CV index (CVI) and CV ratio (CVR). Construct validity was evaluated using exploratory factor analysis and reproducibility was tested based on test-retest reliability using intraclass correlation coefficient (ICC). Internal consistency was calculated using Cronbach's α. RESULTS: The results showed acceptable CVI in relevancy, clarity, and simplicity, acceptable CVR for all items, good internal consistency (Cronbach's alpha = 0.738) and excellent repeatability (ICC = 0.98). CONCLUSION: The Persian version of the PRAFAB questionnaire has acceptable validity and reliability and in future it can be used as a suitable evaluation instrument to assess urinary incontinence in Iranian women.

Experiences of Peri-partum Urinary Incontinence from a Women's and Health Care Perspective: A Qualitative Study.

OBJECTIVES: Urinary incontinence (UI) is highly prevalent peri-partum. To gain more understanding regarding the gap between the prevalence of UI and actual help seeking behaviour of peri-partum women, this study aims to understand, (1) how peri-partum women experience UI and which factors influence these experiences and (2) the perspective of health care professionals on UI during pregnancy, and the first year after childbirth. METHODS: A qualitative approach was used, using semi-structured interviews with adult pregnant and up to 1 year post-partum women and a focus group with health care professionals (HCP's) involved in the care of pregnant and post-partum women. Thematic analysis was used to analyse the data. RESULTS: Six pregnant and seven post-partum women were included. Nearly all of these women expressed to be not, or only slightly bothered by their UI and accept it as a result of pregnancy and/or delivery. They were surprised because they were unaware that UI could be a problem. None of the HCP's routinely asked about the presence of UI during pregnancy. At the post-natal check at 6 weeks post-partum, UI is still not a standard question for the majority of the gynecologists and registrars in contrast to the midwives. CONCLUSIONS FOR PRACTICE: The interviewed women with UI during pregnancy and the first year after childbirth were surprised but hardly bothered by their UI and accept it as part of being pregnant or as a result of the delivery. HCP's do not routinely discuss UI during pregnancy or post-partum.

What is already known on this subject? Peri-partum women with urinary incontinence often believe it is normal and will resolve by itself over time. Health care professionals in peri-partum care, although knowledgeable on urinary incontinence, do not standardly discuss urinary incontinence in The Netherlands. A majority of peri-partum women do not seek professional help.What this study adds? The beliefs peri-partum women have on urinary incontinence probably originates from information from a health care professional, friend or the internet. To disclose their urinary incontinence, women need to be timely and structurally asked by their health care professional. A lack of time is one of the reasons why health care professionals do not standardly discuss this topic.

Management of chronic primary pelvic pain syndromes.

Management of chronic pelvic pain (CPP) remains a huge challenge for care providers and a major burden for healthcare systems. Treating chronic pain that has no obvious cause warrants an understanding of the difficulties in managing these conditions. Chronic pain has recently been accepted as a disease in its own right by the World Health Organization, with chronic pain without obvious cause being classified as chronic primary pain. Despite innumerable treatments that have been proposed and tried to date for CPP, unimodal therapeutic options are mostly unsuccessful, especially in unselected individuals. In contrast, individualised multimodal management of CPP seems the most promising approach and may lead to an acceptable situation for a large proportion of patients. In the present review, the interdisciplinary and interprofessional European Association of Urology Chronic Pelvic Pain Guideline Group gives a contemporary overview of the most important concepts to successfully diagnose and treat this challenging disease.

Prevalence, incidence and bothersomeness of urinary incontinence in pregnancy: a systematic review and meta-analysis.

INTRODUCTION AND HYPOTHESIS: Urinary incontinence (UI) is a common and embarrassing complaint for pregnant women. Reported prevalence and incidence figures show a large range, due to varying case definitions, recruited population and study methodology. Precise prevalence and incidence figures on (bothersome) UI are of relevance for health care providers, policy makers and researchers. Therefore, we conducted a systematic review and meta-analysis to investigate the prevalence and incidence of UI in pregnancy in the general population for relevant subgroups and assessed experienced bother. METHODS: All observational studies published between January 1998 and October 2018 reporting on prevalence and/or incidence of UI during pregnancy were included. All women, regardless of weeks of gestation and type of UI presented in all settings, were of interest. A random-effects model was used. Subgroup analyses were conducted by parity, trimester and subtype of UI. RESULTS: The mean (weighted) prevalence based on 44 included studies, containing a total of 88.305 women, was 41.0% (range of 9-75%). Stress urinary incontinence (63%) is the most prevalent type of UI; 26% of the women reported daily loss, whereas 40% reported loss on a monthly basis. Bother was experienced as mild to moderate. CONCLUSIONS: UI is very prevalent and rising with the weeks of gestation in pregnancy. SUI is the most common type and in most cases it was a small amount. Bother for UI is heterogeneously assessed and experienced as mild to moderate by pregnant women.

Urinary incontinence 6 weeks to 1 year post-partum: prevalence, experience of bother, beliefs, and help-seeking behavior.

INTRODUCTION AND HYPOTHESIS: Post-partum, women often experience urinary incontinence (UI). However, the association between experienced UI bother and UI beliefs and help-seeking behavior is less known. Therefore, we aim to investigate the prevalence of self-reported UI, the level of experienced bother and beliefs, to explain help-seeking behavior for UI in women in the Netherlands from 6 weeks to one year post-partum. METHODS: A digital survey among post-partum women, shared on social media, was used for recruitment. The survey consists of: 1. demographic variables, 2. International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF), 3. ICIQ Lower Urinary Tract Symptoms Quality of Life (ICIQ-LUTSqol), and 4. questions on beliefs and help-seeking behavior. For analysis, descriptive statistics and the independent samples t-test were used to determine differences between help- and non-help-seekers. RESULTS: 415 women filled in the survey. The mean age was 30.6 years (SD 4.0, range 21-40) of which 48.2% was primiparous. The overall prevalence of UI was 57.1% (95% confidence interval (CI) (52.3-61.8)). Primiparous women reported a statistically significantly lower overall prevalence than multiparous women, 52.0% and 61.9% respectively (p = .043). UI was reported as bothersome in 38% of women, 25% of all women sought help. Help-seeking women showed significantly higher scores for bother, measured by the ICIQ-UI SF, than non-help seekers (p = .001). CONCLUSIONS: More than half of all post-partum women in the Netherlands from 6 weeks to one year post childbirth experience UI (57.1%), 38% classified their UI as bothersome. In total 25% of UI women sought professional help.

Prevalence, incidence and bothersomeness of urinary incontinence between 6 weeks and 1 year post-partum: a systematic review and meta-analysis.

INTRODUCTION AND HYPOTHESIS: Urinary incontinence (UI) is a common complaint for post-partum women. Reported prevalence and incidence figures show a large range due to varying study methodology. The crude prevalence of post-partum UI may differ when accounting for bother. Precise prevalence and incidence figures on (bothersome) UI are of relevance for health care providers, research planning, and policy makers. Therefore, we conducted a systematic review and meta-analysis to investigate the prevalence and incidence of UI in post-partum women in the Western world for relevant subgroups and assessed experienced bother in relation to UI. METHODS: Observational studies, published between January 1998 and March 2020 and reporting on prevalence and incidence between 6 weeks and 1 year post-partum, were included, regardless of type of UI or setting. We used a random effects model with subgroup analyses for post-partum period, parity and subtype of UI. RESULTS: The mean (weighted) prevalence based on 24 included studies, containing a total of 35.064 women, was 31.0%. After an initial drop in prevalence at 3 months post-partum, prevalence rises up to nearly the same level as in the third trimester of pregnancy at 1 year post-partum (32%). Stress UI (54%) is the most prevalent type. UI prevalence is equal among primi- and multiparous women. Experienced bother of UI is heterogeneously assessed and reported to be mild to moderate. CONCLUSIONS: Post-partum UI is highly prevalent in women in the Western world. After an initial drop it rises again at 1 year post-partum. Experienced bother is mild to moderate.

Urinary incontinence during pregnancy: prevalence, experience of bother, beliefs, and help-seeking behavior.

INTRODUCTION AND HYPOTHESIS: Pregnancy and delivery are thought to induce urinary incontinence (UI), but its clinical impact is less known. Therefore, we investigated the prevalence of self-reported UI, level of experience of bother, and beliefs to gain a greater understanding of help-seeking behavior in adult pregnant women. METHODS: A digital survey shared on social media was used for recruitment. The survey consists of: (1) demographic variables, (2) International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF), (3) ICIQ Lower Urinary Tract Symptoms Quality of Life (ICIQ-LUTSqol), and (4) questions on beliefs and help-seeking behavior. For analysis, descriptive statistics and the independent samples t-test were used to determine differences between help- and non-help-seekers. RESULTS: Four hundred seven women were eligible for data analysis. The prevalence of UI rises from 55.1% in the first to 70.1% in the third trimester, with an overall prevalence of 66.8%. Nearly 43.0% of the respondents reported UI occurring once a week or less; 92.5% of women lost a small amount; 90% reported slight to moderate impact on quality of life. Only 13.1% of the respondents sought help for their UI. The main reasons for not seeking help were: minimal bother and the idea that UI would resolve by itself. Help-seeking women showed significantly higher scores than non-help-seeking women regarding ICIQ-UI SF (p < 0.001), ICIQ-LUTSqol (p ≤ 0.001), and interference in daily life (p < 0.001). CONCLUSIONS: During pregnancy, UI affects two out of three women, but only one in eight women sought professional help. Non-help-seeking women experience less bother.

The Effects of home-based stabilization exercises focusing on the pelvic floor on postnatal stress urinary incontinence and low back pain: a randomized controlled trial.

INTRODUCTION AND HYPOTHESIS: Stress urinary incontinence (SUI) and low back pain (LBP) are common postnatal problems. We aimed to compare the effects of stabilization exercises focusing on the pelvic floor on postnatal SUI and LBP. METHODS: This two-arm, single-blind, parallel, randomized controlled trial was done on 80 women (mean age: 30.5, range: 20-45 years), with postnatal SUI and LBP. They were randomized into two equal control and intervention groups. The control group received no treatment while the intervention group received home-based stabilization exercises focusing on pelvic floor muscles (PFM) 3 days a week for 12 weeks, three sets a day; each set included three different types of exercise each week. Outcome measures were UI severity, assessed by ICIQ-UI-SF, low back pain functional disability, assessed by the Oswestry Disability Index (ODI), LBP severity, assessed by visual analog scale (VAS), and PFM strength and endurance, assessed by vaginal examination. Transverse abdominis (TrA) muscle strength was assessed by manometric biofeedback. All outcomes were measured directly before and after treatment. RESULTS: In the intervention group, PFM strength, TrA muscle strength, functional disability and pain severity were significantly improved (P < 0.05). Within-group results showed that all outcomes except pain severity (P = 0.06) had directly improved in the intervention group after treatment (P < 0.05), while in the control group only PFM strength and endurance and UI severity had improved (P < 0.05). CONCLUSIONS: Home-based stabilization exercises focusing on the pelvic floor muscles could be effective for postnatal LBP and SUI. TRIAL REGISTRATION: Iranian Registry of Clinical Trials (Code: IRCT2017050618760N4).

Three-dimensional finite element analysis of the pelvic organ prolapse: A parametric biomechanical modeling.

AIMS: To evaluate the role of soft tissue and ligaments damage and level of pelvic muscles activation versus intra-abdominal pressure, on pelvic organ prolapse. METHODS: This was a computational modeling based on the finite element analysis. Three pelvic muscles, four pelvic ligaments, and three organs (urethra, vagina, and rectum) were simulated. The model was subjected to total 41 472 analysis cases including three intra-abdominal pressures, two damaging levels for the ligaments, three damaging levels for the muscles, and four intentional levels of activation for muscles. RESULTS: Increased intra-abdominal pressures caused significant statistical increase of the pelvic organ prolapse (P = 0.000) up to 10 mm downward. Ligaments' defect had no statistically-significant effect on prolapse of the organs (P = 0.981 for rectum, P = 0.423 for urethra, and P = 0.752 for vagina). Damage in the pelvic floor muscles and low intentional level of activation also deteriorated the prolapse (P = 0.000). CONCLUSION: Increase of the intra-abdominal pressure (IAP) as may be existed during pregnancy or physical activity increased the organ prolapse. Damages of the ligaments caused less effects on the prolapse. Loss of the passive properties of the muscles which is probable after delivery or aging moderately deteriorated the prolapse disorder. However, activation of the pelvic floor muscles prevented the prolapse. Different recruitments of the muscles, specifically the pubococcygeus (PCM), could compensate the possible defects in other tissues. Targeted pelvic floor muscle training (PFMT) could also be effective in older adults due to considerable role of the pelvic muscles' intentional activation.

An ideal e-health system for pelvic floor muscle training adherence: Systematic review.

BACKGROUND: Nowadays, Pelvic Floor Muscle Training (PFMT) is a first line, level 1 evidence-based treatment for urinary incontinence (UI), but adherence to PFMT is often problematic. Today, there are several mobile applications (mApps) for PFMT, but many lack specific strategies for enhancing adherence. AIMS: To review available mApps for improvement of adherence to PFMT, and to introduce a new App so called iPelvis. METHODS: Review study all available mApps for PFMT and relevant literature regarding adherence by electronic search through the databases Pubmed, Embase, CINAHL, LILACS, PEDro, and Scielo. Based on these results, development of a mApp, called "iPelvis" for Apple™ and Android™ systems, implementing relevant strategies to improve adherence. RESULTS: Based on the current adherence literature we were able to identify 12 variables helping to create the optimal mApp for PFMT. None of the identified 61 mApps found for Android™ and 16 for Apple™ has all these 12 variables. iPelvis mApp and websites were constructed taking into consideration those 12 variables and its construct is now being subject to ongoing validation studies. CONCLUSION: MApps for PFMT are an essential part of first-line, efficient interventions of UI and have potentials to improve adherence, in case these respect the principles of PFMT, motor learning and adherence to PFMT. iPelvis has been constructed respecting all essential variables related to adherence to PFMT and may enhance the effects of UI treatment.

Pelvic floor rehabilitation in the treatment of women with dyspareunia: a randomized controlled clinical trial.

INTRODUCTION AND HYPOTHESIS: Dyspareunia, the symptom of painful sexual intercourse, is a common sexual dysfunction in reproductive-aged women. Because of its multifactorial etiology, a multidisciplinary approach may be required to treat it. Musculoskeletal factors play an important role; thus, rehabilitating the pelvic floor and modifying the tone of the pelvic floor muscles (PFMs) may be an effective way to treat this dysfunction. The aim of this randomized controlled clinical study was to evaluate the effects of pelvic floor rehabilitation techniques on dyspareunia. METHODS: Of 84 women, assessed for eligibility, 64 women with dyspareunia were randomized into two groups: the experimental group (n = 32) received electrotherapy, manual therapy, and PFM exercises and the control group (n = 32) had no treatment while on the waiting list. Evaluations of PFM strength and endurance, sexual function, and pain were made directly before and after 3 months of treatment and at the 3-month follow-up. RESULTS: Between-group changes showed significant improvement in the experimental group in comparison with control group. Mean difference in the PFM strength (according to the 0-5 Oxford scale) between groups was 2.01 and the mean difference of endurance was 6.26 s. Also, the mean difference in the Female Sexual Function Index score (the score ranges from 2 to 95) was 51.05, and the mean difference in the VAS score was 7.32. All of the changes were statistically significant (p < 0.05). CONCLUSIONS: According to the results, pelvic floor rehabilitation is an important part of a multidisciplinary treatment approach to dyspareunia.

Physiotherapy for pelvic pain and female sexual dysfunction: an untapped resource.

INTRODUCTION AND HYPOTHESIS: Chronic pelvic pain (CPP) in women is a complex syndrome. Pain sensation and intensity often do not correspond with the identified lesion location but are felt elsewhere, leading to muskuloskeletal and myofascial disorders and sexual dysfunction (SD). Although physical aspects are prevalent, they are often underdiagnosed and undertreated due to lack of understanding regarding its origin and distribution. Frequently, patients experience pelvic pain as psychological distress resulting in physical complaints, leading clinicians to prescribe medication or surgical intervention to correct or alleviate these symptoms, often with insufficient results. Because pelvic floor muscle disorders contribute significantly to CPP and SD, there is rationale for physiotherapy. However, physiotherapy is a widely underused and untapped resource, which has its place in the multidisciplinary approach to these health problems. METHODS: Computer-aided and manual searches and methodological quality assessment were carried out for meta-analyses, systematic reviews, and randomized controlled trials (RCTs) published between 1990 and 2017 investigating classification, assessment, and (physiotherapeutic) treatment of pelvic pain and/or female SD defined by the keywords below. Expert opinions were sought via interviews. RESULTS: Due to a lack of sufficient relevant medical information, referral data, and test results, focused physiotherapy is difficult to administer adequately. However, recent quality studies indicate significant clinical effects of physiotherapy for CPP and female SD, and experts advocate a multidisciplinary approach that includes physiotherapy. CONCLUSIONS: Because of its holistic approach, physiotherapy can contribute significantly to the multidisciplinary assessment and treatment of CPP and female SD.

Female double incontinence: prevalence, incidence, and risk factors from the SABE (Health, Wellbeing and Aging) study.

INTRODUCTION AND HYPOTHESIS: Double Incontinence (DI) is incontinence of urine and stool and is an extreme manifestation of pelvic floor dysfunction. The objective of this study was to estimate the prevalence and incidence of DI and the risk factors in elderly women in São Paulo, Brazil. METHODS: This was a prospective study in women aged 65 years or older evaluated in 2006 and re-evaluated in 2010. The sample was selected by two-phase stratified sampling with replacement and probability proportional to size. The likelihood ratio test was performed and Cox regression curves were generated to evaluate the equality of survival. Poisson's regression was used to evaluate risk factors. RESULTS: This is the first study on the incidence of DI in elderly women. A total of 864 elderly women were interviewed in 2006. The prevalence rate of DI was 4.9%. The incidence rate of DI in the period between 2006 and 2010 was 13.8/1,000 person-years. Associated factors were the presence of chronic obstructive pulmonary disease, hypertension, difficulty with basic activities of daily living (BADL) and instrumental activities of daily living (IADL), polypharmacy and falls in the last year. Poisson's regression analysis showed that falls in the last year and difficulty with at least three IADL were risk factors for DI. CONCLUSIONS: The incidence of DI seems to be high in this population. Falls in the last year and difficulty with at least three IADL were identified as risk factors. Preventive measures must be implemented with public health policies to prevent increases in DI.

Prevalence of anxiety and depressive symptoms and their association with pelvic floor dysfunctions-A cross sectional cohort study at a Pelvic Care Centre.

AIMS: Pelvic floor dysfunctions (PFDs), like voiding complaints, urinary and fecal incontinence, and prolapse, are prevalent and associated with decrease in quality of life. PFDs are often complex and multifactorial in origin showing interrelationships between different PFD and with affective conditions. The primary aim of this study is to describe the prevalence of affective complaints in a cohort of Pelvic Care Centre (PCC) patients. The secondary aim is to describe associations between PFDs and depression or anxiety. METHODS: A cross sectional cohort study at an University Hospital's PCC. First contact patients were included in a triage system and filled out questionnaires regarding pelvic floor complaints and Hospital Anxiety and Depression Scale (HADS) scores. Linear (dummy-) regression analysis of HADS scales was performed to test the effects of relevant clinical predictors related, and not directly related, to pelvic floor problems, and demographic characteristics of the patients. RESULTS: From 1862 eligible first-contact PCC patients, 1510 (mean age 57.1) had completed the questionnaire (352 missing, 18.9%). The prevalence of anxiety and depression complaints was 30.9% and 20.3%, respectively. The variance explained for depression score by PFDs was 0.12 and 0.074 for anxiety. CONCLUSIONS: Anxiety and depression are prevalent (30.9% and 20.3%, respectively) in a cohort of PFDs. PFDs can explain variance within anxiety and depression complaints. Corrected for other contributing variables, 12% of depression and 7.4% of anxiety was directly related to PFDs. We advocate a multidisciplinary approach, containing psychometric assessment for PFDs in order to obtain better diagnostic results and personalized treatment options.

An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female anorectal dysfunction.

INTRODUCTION: The terminology for anorectal dysfunction in women has long been in need of a specific clinically-based Consensus Report. METHODS: This Report combines the input of members of the Standardization and Terminology Committees of two International Organizations, the International Urogynecological Association (IUGA) and the International Continence Society (ICS), assisted on Committee by experts in their fields to form a Joint IUGA/ICS Working Group on Female Anorectal Terminology. Appropriate core clinical categories and sub classifications were developed to give an alphanumeric coding to each definition. An extensive process of twenty rounds of internal and external review was developed to exhaustively examine each definition, with decision-making by collective opinion (consensus). RESULTS: A Terminology Report for anorectal dysfunction, encompassing over 130 separate definitions, has been developed. It is clinically based with the most common diagnoses defined. Clarity and user-friendliness have been key aims to make it interpretable by practitioners and trainees in all the different specialty groups involved in female pelvic floor dysfunction. Female-specific anorectal investigations and imaging (ultrasound, radiology and MRI) has been included whilst appropriate figures have been included to supplement and help clarify the text. Interval review (5-10 years) is anticipated to keep the document updated and as widely acceptable as possible. CONCLUSION: A consensus-based Terminology Report for female anorectal dysfunction terminology has been produced aimed at being a significant aid to clinical practice and a stimulus for research. Neurourol. Urodynam. 36:10-34, 2017. © 2016 Wiley Periodicals, Inc., and The International Urogynecological Association.

An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for the conservative and nonpharmacological management of female pelvic floor dysfunction.

Introduction and hypothesis There has been an increasing need for the terminology on the conservative management of female pelvic floor dysfunction to be collated in a clinically based consensus report. Methods This Report combines the input of members and elected nominees of the Standardization and Terminology Committees of two International Organizations, the International Urogynecological Association (IUGA) and the International Continence Society (ICS), assisted at intervals by many external referees. An extensive process of nine rounds of internal and external review was developed to exhaustively examine each definition, with decision-making by collective opinion (consensus). Before opening up for comments on the webpages of ICS and IUGA, five experts from physiotherapy, neurology, urology, urogynecology, and nursing were invited to comment on the paper. Results A Terminology Report on the conservative management of female pelvic floor dysfunction, encompassing over 200 separate definitions, has been developed. It is clinically based, with the most common symptoms, signs, assessments, diagnoses, and treatments defined. Clarity and ease of use have been key aims to make it interpretable by practitioners and trainees in all the different specialty groups involved in female pelvic floor dysfunction. Ongoing review is not only anticipated, but will be required to keep the document updated and as widely acceptable as possible. Conclusion A consensus-based terminology report for the conservative management of female pelvic floor dysfunction has been produced, aimed at being a significant aid to clinical practice and a stimulus for research.

Electrical stimulation with non-implanted devices for stress urinary incontinence in women.

BACKGROUND: Several treatment options are available for stress urinary incontinence (SUI), including pelvic floor muscle training (PFMT), drug therapy and surgery. Problems exist such as adherence to PFMT regimens, side effects linked to drug therapy and the risks associated with surgery. We have evaluated an alternative treatment, electrical stimulation (ES) with non-implanted devices, which aims to improve pelvic floor muscle function to reduce involuntary urine loss. OBJECTIVES: To assess the effects of electrical stimulation with non-implanted devices, alone or in combination with other treatment, for managing stress urinary incontinence or stress-predominant mixed urinary incontinence in women. Among the outcomes examined were costs and cost-effectiveness. SEARCH METHODS: We searched the Cochrane Incontinence Specialised Register, which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, MEDLINE In-Process, MEDLINE Epub Ahead of Print, CINAHL, ClinicalTrials.gov, WHO ICTRP and handsearches of journals and conference proceedings (searched 27 February 2017). We also searched the reference lists of relevant articles and undertook separate searches to identify studies examining economic data. SELECTION CRITERIA: We included randomised or quasi-randomised controlled trials of ES with non-implanted devices compared with any other treatment for SUI in women. Eligible trials included adult women with SUI or stress-predominant mixed urinary incontinence (MUI). We excluded studies of women with urgency-predominant MUI, urgency urinary incontinence only, or incontinence associated with a neurologic condition. We would have included economic evaluations had they been conducted alongside eligible trials. DATA COLLECTION AND ANALYSIS: Two review authors independently screened search results, extracted data from eligible trials and assessed risk of bias, using the Cochrane 'Risk of bias' tool. We would have performed economic evaluations using the approach recommended by Cochrane Economic Methods. MAIN RESULTS: We identified 56 eligible trials (3781 randomised participants). Eighteen trials did not report the primary outcomes of subjective cure, improvement of SUI or incontinence-specific quality of life (QoL). The risk of bias was generally unclear, as most trials provided little detail when reporting their methods. We assessed 25% of the included trials as being at high risk of bias for a variety of reasons, including industry funding and baseline differences between groups. We did not identify any economic evaluations.For subjective cure of SUI, we found moderate-quality evidence that ES is probably better than no active treatment (risk ratio (RR) 2.31, 95% CI 1.06 to 5.02). We found a similar result for cure or improvement of SUI (RR 1.73, 95% CI 1.41 to 2.11), but the quality of evidence was lower. We are very uncertain if there is a difference between ES and sham treatment in terms of subjective cure because of the very low quality of evidence (RR 2.21, 95% CI 0.38 to 12.73). For subjective cure or improvement, ES may be better than sham treatment (RR 2.03, 95% CI 1.02 to 4.07). The effect estimate was 660/1000 women cured/improved with ES compared to 382/1000 with no active treatment (95% CI 538 to 805 women); and for sham treatment, 402/1000 women cured/improved with ES compared to 198/1000 with sham treatment (95% CI 202 to 805 women).Low-quality evidence suggests that there may be no difference in cure or improvement for ES versus PFMT (RR 0.85, 95% CI 0.70 to 1.03), PFMT plus ES versus PFMT alone (RR 1.10, 95% CI 0.95 to 1.28) or ES versus vaginal cones (RR 1.09, 95% CI 0.97 to 1.21).Electrical stimulation probably improves incontinence-specific QoL compared to no treatment (moderate quality evidence) but there may be little or no difference between electrical stimulation and PFMT (low quality evidence). It is uncertain whether adding electrical stimulation to PFMT makes any difference in terms of quality of life, compared with PFMT alone (very low quality evidence). There may be little or no difference between electrical stimulation and vaginal cones in improving incontinence-specific QoL (low quality evidence). The impact of electrical stimulation on subjective cure/improvement and incontinence-specific QoL, compared with vaginal cones, PFMT plus vaginal cones, or drugs therapy, is uncertain (very low quality evidence).In terms of subjective cure/improvement and incontinence-specific QoL, the available evidence comparing ES versus drug therapy or PFMT plus vaginal cones was very low quality and inconclusive. Similarly, comparisons of different types of ES to each other and of ES plus surgery to surgery are also inconclusive in terms of subjective cure/improvement and incontinence-specific QoL (very low-quality evidence).Adverse effects were rare: in total nine of the women treated with ES in the trials reported an adverse effect. We identified insufficient evidence to compare the risk of adverse effects in women treated with ES compared to any other treatment. We were unable to identify any economic data. AUTHORS' CONCLUSIONS: The current evidence base indicated that electrical stimulation is probably more effective than no active or sham treatment, but it is not possible to say whether ES is similar to PFMT or other active treatments in effectiveness or not. Overall, the quality of the evidence was too low to provide reliable results. Without sufficiently powered trials measuring clinically important outcomes, such as subjective assessment of urinary incontinence, we cannot draw robust conclusions about the overall effectiveness or cost-effectiveness of electrical stimulation for stress urinary incontinence in women.

An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female anorectal dysfunction.

INTRODUCTION AND HYPOTHESIS: The terminology for anorectal dysfunction in women has long been in need of a specific clinically-based Consensus Report. METHODS: This Report combines the input of members of the Standardization and Terminology Committees of two International Organizations, the International Urogynecological Association (IUGA) and the International Continence Society (ICS), assisted on Committee by experts in their fields to form a Joint IUGA/ICS Working Group on Female Anorectal Terminology. Appropriate core clinical categories and sub classifications were developed to give an alphanumeric coding to each definition. An extensive process of twenty rounds of internal and external review was developed to exhaustively examine each definition, with decision-making by collective opinion (consensus). RESULTS: A Terminology Report for anorectal dysfunction, encompassing over 130 separate definitions, has been developed. It is clinically based with the most common diagnoses defined. Clarity and user-friendliness have been key aims to make it interpretable by practitioners and trainees in all the different specialty groups involved in female pelvic floor dysfunction. Female-specific anorectal investigations and imaging (ultrasound, radiology and MRI) has been included whilst appropriate figures have been included to supplement and help clarify the text. Interval review (5-10 years) is anticipated to keep the document updated and as widely acceptable as possible. CONCLUSIONS: A consensus-based Terminology Report for female anorectal dysfunction terminology has been produced aimed at being a significant aid to clinical practice and a stimulus for research.

An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for the conservative and nonpharmacological management of female pelvic floor dysfunction.

INTRODUCTION AND HYPOTHESIS: There has been an increasing need for the terminology on the conservative management of female pelvic floor dysfunction to be collated in a clinically based consensus report. METHODS: This Report combines the input of members and elected nominees of the Standardization and Terminology Committees of two International Organizations, the International Urogynecological Association (IUGA) and the International Continence Society (ICS), assisted at intervals by many external referees. An extensive process of nine rounds of internal and external review was developed to exhaustively examine each definition, with decision-making by collective opinion (consensus). Before opening up for comments on the webpages of ICS and IUGA, five experts from physiotherapy, neurology, urology, urogynecology, and nursing were invited to comment on the paper. RESULTS: A Terminology Report on the conservative management of female pelvic floor dysfunction, encompassing over 200 separate definitions, has been developed. It is clinically based, with the most common symptoms, signs, assessments, diagnoses, and treatments defined. Clarity and ease of use have been key aims to make it interpretable by practitioners and trainees in all the different specialty groups involved in female pelvic floor dysfunction. Ongoing review is not only anticipated, but will be required to keep the document updated and as widely acceptable as possible. CONCLUSION: A consensus-based terminology report for the conservative management of female pelvic floor dysfunction has been produced, aimed at being a significant aid to clinical practice and a stimulus for research.

Cost-effectiveness of a nurse-led intervention to optimise implementation of guideline-concordant continence care: Study protocol of the COCON study.

BACKGROUND: Guidelines on urinary incontinence recommend that absorbent products are only used as a coping strategy pending definitive treatment, as an adjunct to ongoing therapy, or for long-term management after all treatment options have been explored. However, these criteria are rarely met and a significant share of long-term product users could still benefit from therapeutic interventions recommended in guidelines for urinary incontinence. Better implementation of these guidelines can potentially result in both health benefits for women and long-term cost savings for society. The aim of the COCON study is to evaluate the (cost-)effectiveness of a nurse-led intervention to optimise implementation of guideline-concordant continence care in comparison with usual care for urinary incontinent women aged 55 years and over who use absorbent products. METHODS: This randomised clinical trial compares usual care with a nurse-led intervention to optimise implementation of guideline-concordant continence care. Women (anticipated N = 160) are recruited in 12 community pharmacies in three Dutch regions, and are eligible for trial entry when they are 55 years and over, community-dwelling and long-term users of absorbent products (≥4 months) reimbursed by health insurance. Measurements are administered at baseline, 3, 6 and 12 months. Primary outcome is severity of urinary incontinence (ICIQ-UI SF); other outcomes include health related quality of life (EQ-5D-5 L), use of absorbent products (in accordance with the recommended criteria in guidelines) (yes/no), and societal costs. Mixed model analysis will be performed to compare (the course) of outcomes between groups. The economic evaluation will be performed from a societal perspective. The implementation process is investigated using the Tailored Implementation for Chronic Diseases (TICD) framework. DISCUSSION: Results will add to current knowledge of the (cost-)effectiveness of nurse-led primary healthcare to improve guideline-concordant care for older women with urinary incontinence. In addition, the results will provide more insight into care needs and health service utilization of this group of women, as well as into use of absorbent products in accordance with the recommended criteria in guidelines. Finally, results will increase our understanding of the intervention's uptake and could provide useful insights for future dissemination and sustenance. TRIAL REGISTRATION: Dutch Trial Register NTR4396, registered 13-January-2014.