Risk factors associated with stress urinary incontinence 12 years after first delivery.

INTRODUCTION AND HYPOTHESIS: This study was aimed at investigating risk factors involved in stress urinary incontinence (SUI) 12 years after first delivery. We also evaluated cumulative incidence, severity, and impact on quality of life (QoL) of SUI. We hypothesized that changes during the first pregnancy might be associated with SUI long after delivery. METHODS: A longitudinal cohort study was undertaken including primigravid women who delivered in our hospital during 2007. SUI was assessed following definitions of the International Continence Society. Severity was evaluated using the Incontinence Severity Index and impact on QoL with the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form. Comparisons between continuous variables were performed using Student's t test and between qualitative variables using Chi-squared tests. A logistic regression model was constructed including variables that reached statistical significance (p < 0.05) in the univariate analysis. RESULTS: During the inclusion period, 479 pregnant women were interviewed, 381 attended the 6-month follow-up, and 318 completed the questionnaires 12 years after and formed the study group. The cumulative incidence of SUI at 6 months and 12 years postpartum was 14.2% and 39.6% respectively. Generally, SUI severity was slight (73.0%) or moderate (28.9%) and its impact on QoL was low. Pregnancy SUI (OR: 2.14; 95% CI: 1.29-3.55) was independently associated with SUI 12 years postpartum. CONCLUSION: The cumulative incidence of SUI increases markedly from 6 months to 12 years postpartum, being slight or moderate in severity and having a low impact on QoL in most cases. Developing SUI during pregnancy doubled the risk of SUI 12 years postpartum.

Factors involved in the persistence of stress urinary incontinence from postpartum to 12 years after first delivery.

AIMS: The aim of this study was to investigate constitutional-, pregnancy-, labor-, and delivery-related factors involved in the long-term persistence of stress urinary incontinence (SUI) from 6 months postpartum to 12 years after first delivery. We also evaluated severity and impact on quality of life of persistent SUI. METHODS: This was a longitudinal study including primigravid women who gave birth at our Public Health Hospital during 2007. Urinary symptoms were investigated at inclusion, 6 months and 12 years after delivery. Persistent SUI was defined as SUI reported both at 6 months postpartum and 12 years after first delivery. The International Consultation on Incontinence-Urinary Incontinence-Short Form (ICIQ-UI-SF) and the Incontinence Severity Index (ISI) were used to evaluate SUI. RESULTS: During the inclusion period, 479 pregnant women were interviewed, 381 attended the 6-month follow-up visit, and 315 formed the study group. SUI persisted in 36 out of 44 (81.8%) women. With the ISI, 52.8% of these women were categorized as having slight, 41.7% moderate, and 5.6% severe incontinence. The mean ICIQ-UI-SF score was 7.13 (SD 3.51). Pregnancy SUI (odds ratio [OR], 4.54; 95% confidence interval [CI], 2.10-9.80) and active second stage of labor more than or equal to 1 hour (OR, 3.68; 95% CI, 1.21-11.14) were independently associated with persistent SUI. CONCLUSIONS: Women who reported SUI during pregnancy, and those who had pushed for more than or equal to 1 hour in the second stage of labor were at greater risk of SUI persisting from 6 months postpartum to long after delivery. We found this independent association after controlling for several constitutional-, pregnancy-, labor-, and delivery-related variables.

Nontraditional Lipid Variables Predict Recurrent Brain Ischemia in Embolic Stroke of Undetermined Source.

OBJECTIVE: The aims of this study are, first, to calculate the risk of brain ischemia recurrence and embolic source diagnosis in the follow-up of patients with ESUS (embolic stroke of undetermined source) and, second, to identify the predictors of these events including cardiologic, laboratory, and clinical factors. METHODS: A retrospective observational cohort study of stroke patients admitted to the stroke unit in a single tertiary hospital from 2012 to 2014 was performed. Patients fulfilling ESUS criteria were identified and followed by medical history review until March 2016. Statistical analysis comprised Kaplan-Meier analysis and Cox proportional hazards multivariate analysis including clinical characteristics, cardiologic data, and blood test results. RESULTS: One hundred and thirteen patients, 8.3% of the overall stroke patients, filled ESUS criteria and they were younger, had less vascular risk factors, and suffered milder strokes than the remainder of stroke patients. Median follow-up of ESUS was 25.6 months. Risk of brain ischemia recurrence was 8.4, 10.8, and 15% at 12, 24, and 36 months, respectively, and was associated to age (HR 1.07, P = .027) and to a higher total cholesterol (TC)/high-density lipoprotein (HDL)-cholesterol (HR = 1.38, P = .002) and low-density lipoprotein (LDL)-cholesterol/HDL-cholesterol ratios (HR = 1.48, P = .001). The risk of major embolic source diagnosis was 6.7, 7.8, 13.6% at 12, 24, and 36 months, and was associated to female sex (HR = 6.05, P = .021). CONCLUSIONS: Brain ischemia recurrence increases with age and increased values of nontraditional lipid variables, TCHDLr and LDLHDLr, in ESUS patients, and women are more frequently diagnosed with a major embolic source in the follow-up.