A Randomized Controlled Trial of a Multimedia Patient Education Tool for Stress Versus Urgency Urinary Incontinence.

OBJECTIVE: The aim of this study was to determine whether there was a difference in patient education when comparing traditional conversation-based patient counseling with multimedia-based patient counseling about stress and urgency urinary incontinence. METHODS: Patients seeking treatment for urinary incontinence were randomized to traditional, conversation-based counseling from a physician regarding stress and urgency urinary incontinence (control group) or view a video (multimedia) as their counseling (treatment group). A vignette-based assessment of the patient's knowledge of stress and urgency urinary incontinence was administered as a pretest, immediate posttest, and 6- to 8-week delayed posttest. The Incontinence Impact Questionnaire, short form, was used to assess quality of life and was administered at the initial visit and at the 6- to 8-week follow-up call. Patient satisfaction was recorded at the end of the initial visit using a continuous visual analog scale, and health literacy was evaluated using the Rapid Estimate of Adult Literacy in Medicine-Short Form or Short Assessment of Health Literacy-Spanish. RESULTS: In the 98 participants, immediate posttest scores trended toward significance between the control and treatment groups (P = 0.086). This trend was lost at the delayed posttest (P = 0.122). Both methods of education showed a significant difference between pretest, immediate posttest, and delayed posttest (P < 0.001). There were no demographic differences between groups. CONCLUSIONS: Multimedia-based patient education represents an effective method of providing patient education regarding urinary incontinence because those who received video education showed comparable comprehension of this topic when compared with standard physician counseling. Video education can feasibly be used as an alternative to, or in conjunction with, current patient education practices in a urogynecology setting.

Feasibility of a Fully Implanted, Nickel Sized and Shaped Tibial Nerve Stimulator for the Treatment of Overactive Bladder Syndrome with Urgency Urinary Incontinence.

PURPOSE: We performed a clinical feasibility trial to evaluate the safety and efficacy of a fully implanted, primary battery powered, nickel sized and shaped neuromodulation device called the eCoin® for tibial nerve stimulation to treat refractory urgency urinary incontinence. MATERIALS AND METHODS: This prospective, single arm, open label study included 46 participants with refractory urgency urinary incontinence. It was performed at multiple sites in the United States and New Zealand. The device was implanted in the lower leg over the tibial nerve and activated after 4 weeks. Bladder diary data and validated quality of life instruments were collected 3 and 6 months after activation and compared to baseline values. RESULTS: The mean ± SD age of participants was 63.4 ± 11.5 years and 45 (98%) were female. Episodes of urgency urinary incontinence were reduced a relative median of 71% after 3 months of treatment (4.2 vs 1.7 daily episodes at 3 months, p = 0.001). A 50% or greater decrease in reported episodes of urgency urinary incontinence was observed in 32 of 46 participants (69.6%) at 3 months with more than 20% dry at 3 and 6 months. I-QOL (Incontinence Quality of Life) scores improved an average of 25.9 points and 33 of 46 patients (72%) indicated improvement in symptoms. A single serious adverse event secondary to wound care resolved with intravenous antibiotics. CONCLUSIONS: The implantable neuromodulation device was a safe and effective treatment of urgency urinary incontinence associated with overactive bladder syndrome with a significant reduction or resolution of symptoms and no significant safety concerns.

Barriers to Exercise Among Women With Urgency Urinary Incontinence: Patient and Provider Perspectives.

OBJECTIVE: The aim of this study was to describe important barriers to exercise in older women with urgency urinary incontinence (UUI) from the patient and provider perspectives. METHODS: Six focus groups (2 in active women, 2 in sedentary women, and 2 in providers) were conducted with 36 women with UUI and 18 providers. Focus group discussions were transcribed verbatim. All transcripts were coded and analyzed by 2 independent reviewers. Investigators identified emergent themes and concepts using a modified biopsychosocial conceptual model. RESULTS: A wide range of physical, psychological, social, and environmental factors were perceived to influence exercise. Although women with UUI identified pain as a strong barrier to exercise, providers did not. Both women with UUI and providers identified shame associated with incontinence as a significant barrier, and, conversely, satisfaction with UUI treatment was noted as an enabler for exercising. Women and providers had incongruent views on the need for supervision during exercise; women viewed supervision as a barrier to exercise, whereas providers viewed lack of supervision as a barrier to exercise. Opportunity for socialization was noted as a major enabler of exercise by all groups and suggests that exercise programs that promote interactions with peers may increase exercise participation. The importance of financial incentive and reimbursement was congruent between women and their providers. CONCLUSIONS: Women with UUI have unique perspectives on barriers to exercise. Understanding women's perspective can aid clinicians and researchers in improving exercise counseling and in creating exercise programs for women with UUI.

Prospective Randomized Feasibility Study Assessing the Effect of Cyclic Sacral Neuromodulation on Urinary Urge Incontinence in Women.

OBJECTIVES: The aim of this prospective, randomized, multicenter, single-blind, 4 × 4 crossover study was to estimate the effect of 4 InterStim cycling settings (continuous, 16 seconds on/8 seconds off, 10 minutes on/10 minutes off, and 30 minutes on/23.5 hours off) on efficacy, Global Response Assessment, and safety. METHODS: Eligible women implanted for at least 3 months for urgency urinary incontinence (UI) were enrolled, and daily diaries were collected. General linear mixed models were used to estimate the cycling effect on efficacy. Quality of life measured by Global Response Assessment (subjects' perception of effectiveness) and safety were summarized. RESULTS: Primary efficacy analysis was based on the first 24 subjects who completed unique randomization sequences. Mean age was 64 years, and mean implant duration was 2.8 years. Results showed no significant cycling (P = 0.3773) or period (P = 0.0800) effect on UI. There was a statistically significant interaction between cycling and period (P = 0.0032). In the first period, subjects on 10 minutes on/10 minutes off had significantly fewer UI episodes compared with subjects on 16 seconds on/8 seconds off (P = 0.0026); this difference was not observed in any other period or sensitivity analyses. No cycling effect was found on urgency or pad usage. When programmed to 10 minutes on/10 minutes off, 54% of subjects felt their incontinence symptoms improved compared with when they entered the study, followed by 42% on 30 minutes on/23.5 hours off, 38% on 16 seconds on/8 seconds off, and 29% on continuous. Safety was similar across cycling settings. CONCLUSIONS: The results suggest that patients with overactive bladder who have been implanted with sacral neuromodulation devices and are receiving substantial benefit may perceive further optimization by switching to cycling settings.

Changes in incontinence after hysterectomy.

PURPOSE: Information about the perioperative incontinence following hysterectomy is limited. To advance the postoperative rehabilitation further we need more information about qualitative changes in incontinence, fatigue and physical function of patients undergoing hysterectomy. METHODS: 108 patients undergoing planned hysterectomy were compared pre- and postoperatively. In a sub-study of the prospective follow-up study the changes in incontinence, postoperative fatigue, quality of life, physical function, and body composition were evaluated preoperatively, 13 and 30 days postoperatively. Sample size calculation indicated that 102 women had to be included. The incontinence status was estimated by a Danish version of the ICIG questionnaire; further, visual analogue scale, dynamometer for hand grip, knee extension strength and balance were applied. Work capacity was measured ergometer cycle together with lean body mass by impedance. Quality of life was assessed using the SF-36 questionnaire. Patients were examined preoperatively and twice postoperatively. RESULTS: In total 41 women improved their incontinence after hysterectomy and 10 women reported deterioration. Preoperative stress incontinence correlated with BMI (r = 0.25, p < 0.01) and urge incontinence with age (r = 0.24, p < 0.02). Further, improvement after hysterectomy in stress incontinence was associated with younger age (r = 0.20, p < 0.04). Improvement in urge incontinence was positively associated with BMI (r = 0.22, p = 0.02). A slight but significant loss was seen in lean body mass 13 and 30 days postoperatively. CONCLUSIONS: Hysterectomy was not significantly associated with the risk of incontinence; in particular, when no further vaginal surgery is performed. Hysterectomy may even have a slightly positive effect on incontinence and de-novo cure.

Evaluation of the prevalence, type, severity, and risk factors of urinary incontinence and its impact on quality of life among women in Turkey.

INTRODUCTION AND HYPOTHESIS: Our purpose was to determine prevalence, type, and risk factors of urinary incontinence (UI) and their impacts on quality of life (QoL) of women in Turkey. METHODS: This cross-sectional study was performed on 150 women aged 18-80 years at the Yildirim Beyazit University Hospital's Gynecology Outpatient Clinic in Turkey between May 2013 and September 2013. Data were collected using an individual information form and an incontinence QoL questionnaire (I-QOL). Following data distribution, we used the Mann-Whitney U test, Bonferroni-corrected Kruskal-Walis H test, logistic regression analysis, Fisher's exact test, and the chi-square test. RESULTS: Mean age of the study population was 48.7 ± 14.3 years and UI prevalence 86.7 %. The distribution of UI types was 37.7 % stress incontinence (SUI), 3.1 % urge (UUI), and 59.2 % mixed (MUI). I-QOL general average was 56.7 ± 23.28 (min 22, max 110). Most women had experienced UI for at least 5 continuous years and reported a negative impact on QoL; 43.2 % of incontinence women had not received medical therapy. Postmenopause, uterine prolapsus, episiotomy, use of hormone replacement therapy (HRT), smoking, caffeine intake, family history of UI, macrosomia, and multiparity were risk factors for UI (p < 0.05). CONCLUSION: In this study, the prevalence of UI in women was substantial, and UI had a significantly negative impact on all aspects of QoL. However, these women had not sought medical help for the problem. Therefore, health professionals should query women of all ages about symptoms of this prevalent condition and offer treatment if it is detected.

Urinary incontinence: prevalence, pattern, and opportunistic screening in Ile-Ife, Nigeria.

INTRODUCTION AND HYPOTHESIS: Urinary incontinence is a source of health-related poor quality of life. It is, however, rarely disclosed, except when specifically enquired about by the healthcare provider. This study determined the prevalence of urinary incontinence and opportunistic screening for it in women attending a general outpatient clinic. METHODS: A total of 1,250 consenting women attending a general outpatient clinic in Ile-Ife, a semi-urban town in Southwest Nigeria, were recruited into this cross-sectional study. Confidential post-consultation interviews were performed in each patient to determine whether they had been asked about urinary incontinence and whether they felt that they ought to have been asked. The Questionnaire for Urinary Incontinence Diagnosis (QUID) was administered to determine the prevalence and pattern of urinary incontinence. Results were expressed as proportions and compared using the Chi-squared test. RESULTS: The subjects' ages ranged from 20 to 100 years (mean = 46.8 ± 17.7 years). Sixty-five women had urinary incontinence (prevalence = 5.2 %). QUID classified 30 (2.4 %), 23 (1.8 %), and 12 (1.0 %) of them as having urge, stress, and mixed incontinence respectively. None of them self-reported incontinence to their physicians. Only 9 incontinent (13.8 %) and 44 continent women (3.7 %) had opportunistic screening (p < 0.001). Fifty of the incontinent women (76.9 %) felt that their physician ought to have asked them about it. Forty-eight of them (73.8 %) did not consider incontinence a sufficient reason for presentation in hospital, but the majority (90.7 %) desired treatment. CONCLUSION: Urinary incontinence was occasionally present, but usually undisclosed by women attending the general outpatient clinic, unless when specifically asked by their physicians. Opportunistic screening is therefore recommended in this setting.

Correlation between psychological stress levels and the severity of overactive bladder symptoms.

BACKGROUND: The relationship between psychological stress and interstitial cystitis/bladder pain syndrome (IC/BPS) has been well described. Even though there is some overlapping of symptoms between overactive bladder (OAB) and IC/BPS, there have been very few studies that specifically investigated the relationship between psychological stress and urinary symptoms in OAB patients who do not have pelvic pain. Here we examined the relationship between psychological stress levels and the severity of overactive bladder (OAB) symptoms. METHODS: Patients diagnosed with OAB (n=51), IC/BPS (n=27), and age-matched healthy controls (n=30) participated in a case control study that inquired about their psychological stress levels using the perceived stress scale (PSS). PSS reported by the three patient groups were compared. Among OAB patients, their responses on the PSS was correlated to OAB symptoms using the following questionnaires: 1) international consultation on incontinence - urinary incontinence (ICIQ-UI), 2) international consultation on incontinence - overactive bladder (ICIQ-OAB), 3) OAB-q short form, 4) urogenital distress inventory (UDI-6), 5) incontinence impact questionnaire (IIQ-7), 6) urgency severity scale (USS), 7) numeric rating scales of urgency symptom, and 8) frequency symptom. Spearman's correlation tests were performed to examine the relationship between psychological stress levels and the severity of OAB symptoms. RESULTS: OAB patients reported psychological stress levels that were as high as IC/BPS patients (median 17.0 versus 18.0, p=0.818, Wilcoxon sum rank test), and significantly higher than healthy controls (17.0, versus 7.5, p=0.001). Among OAB patients, there was a positive correlation between perceived stress levels and urinary incontinence symptoms (ICIQ-UI, Spearman's correlation coefficient=0.39, p=0.007), and impacts on quality of life (UDI-6, IIQ-7, OAB-q quality of life subscale; Spearman's correlation coefficient=0.32, 0.31, 0.39, and p=0.028, 0.005, 0.029, respectively). No significant correlation was observed between perceived stress levels and urgency or frequency symptoms (ICIQ-OAB, USS, numeric ratings of urgency and frequency). CONCLUSIONS: OAB patients reported psychological stress levels that were as high as IC/BPS patients, and significantly higher than healthy controls. There was a positive correlation between perceived stress levels and urinary incontinence symptoms, and its impacts on quality of life among OAB patients.

Effect of home-based Kegel exercises on quality of life in women with stress and mixed urinary incontinence.

The aim of this study was to assess the effects of home-based Kegel exercises in women with stress and mixed urinary incontinence. A total of 90 women with urodynamically proven urinary stress (SUI) and mixed (MUI) incontinence awaiting anti-incontinence surgery were recruited in the urogynaecology clinic of Ankara Zekai Tahir Burak Women's Health Research and Education Hospital. Of these, 18 women were excluded due to low compliance and the remaining 72 were divided into two groups according to urodynamic diagnosis (SUI group, n = 38; MUI group, n = 34). Age, BMI, menopausal status and medical history of the women were recorded. The women took Kegel exercise, consisting of 10 sets of contractions/day; each set included 10 repetitions, for at least 8 weeks. To evaluate the pelvic floor muscle strength, the modified Oxford grading system was used before and after Kegel exercising. The Incontinence Impact Questionnaire (IIQ-7); Urogenital Distress Inventory (UDI-6) and the Patient Global Impression of Improvement (PGI-I) questions were compared before and after 8 weeks of Kegel exercising. The age, BMI, gravidity, menopausal status, macrosomic fetus history, hypertension and asthma were similar between the groups. There were statistically significant lower scores in both IIQ-7 and UDI-6 before and after Kegel exercises within each group (p < 0.001). The mean change of the IIQ-7 and UDI-6 score was statistically significantly higher in the SUI group than in the MUI group (p = 0.023 and p = 0.003, respectively). Results of the Oxford scale were also statistically significantly higher after Kegel exercises within each group (p = < 0.001). In total, 68.4% of the women in the SUI group and 41.2% of the women in the MUI group reported improvements which were statistically significant (p = 0.02). We conclude that home-based Kegel exercises, with no supervision, have been found effective in women with SUI and MUI. The improvement was more prominent in women with SUI.

What predicts and what mediates the response of urge urinary incontinence to biofeedback?

AIMS: To better target a behavioral approach for urge urinary incontinence (UUI) and enhance its efficacy by (1) identifying predictors of response to biofeedback-assisted pelvic muscle training (BFB), and (2) determining factors that mediate response. METHODS: BFB (four biweekly visits) was administered to 183 women > 60 years (mean = 73.6). Before and after intervention, all underwent comprehensive evaluation and videourodynamic testing. Postulated predictors and mediators from four urodynamic domains, specified a priori, were correlated with reduction in UUI frequency. RESULTS: Median UUI frequency decreased from 3.2/day to 1/day (P =0.0001). UUI improved by ≥50% in 55% of subjects and by 100% in 13% of subjects. Frequent UUI predicted poor response (P < 0.01). Of the urodynamic parameters, only high amplitude and briskness of detrusor overactivity (DO) predicted decreased response (P < 0.05 and P < 0.01) and these could be measured only in the 43% of subjects with elicitable DO. Decreased DO elicitability was the only urodynamic variable that changed in concert with improvement and thus was a candidate mediator. Response was neither predicted nor mediated by proprioception/warning, cystometric capacity, detrusor contractility, sphincter strength, or baseline DO elicitability. CONCLUSIONS: Severe DO predicts poor response to BFB. Good response is mediated by reduction in DO elicitability. Other than baseline UUI frequency, there are no other clinically or urodynamically important predictors or mediators of BFB response in this population. BFB may be best for patients with less severe DO. Future research to enhance its efficacy might better focus on the brain than on the lower urinary tract.

Mindfulness-based stress reduction for treatment of urinary urge incontinence: a pilot study.

OBJECTIVE: The objective of the study was to evaluate if a mindfulness-based stress reduction program is a viable treatment worthy of further evaluation for the treatment of urinary urge incontinence. METHODS: This was a single-arm pilot study of 7 women who participated in an 8-week mindfulness-based stress reduction program to evaluate its effectiveness in reducing urinary leakage episodes. Improvement was measured by 3-day bladder diary, Overactive Bladder Symptom and Quality of Life-Short Form, Health-Related Quality of Life, and Patient Global Impression of Improvement. Outcome data were analyzed by means of paired t tests. RESULTS: Mean incontinence episodes per day decreased from 4.14 (SD, 1.96; range, 2.67-7.67) at baseline to 1.23 (SD, 0.93; range, 0.33-2.67) after treatment (P = 0.0005 for change). After treatment, 5 of 7 women were improved based on the Patient Global Impression of Improvement, and 2 were unchanged. Significant improvements on both Health-Related Quality of Life and Overactive Bladder Symptom and Quality of Life-Short Form were reported after treatment. Results were sustained at 1 year in 4 of 7 women. Two women sought treatment, and one was lost to follow-up at 12 months. CONCLUSIONS: Mindfulness-based stress reduction appears to be a treatment worthy of further study, as in the short term, it is as effective as historical studies of drug treatment and bladder training in reducing urge incontinence and incontinence-related quality of life.

Treatment of mixed urinary incontinence in women.

PURPOSE OF REVIEW: Deciding on an optimal therapy for mixed urinary incontinence (MUI) is challenging, as a single-treatment modality may be inadequate for alleviating both the urge and stress component. A MEDLINE search was conducted regarding English-language literature pertaining to the treatment for MUI focusing on literature within the last 18 months. RECENT FINDINGS: Behavioral therapy and lifestyle modification, such as moderate weight loss and caffeine reduction, should be considered first-line options for all women with MUI. The addition of pelvic floor muscle therapy may have an additional salutary effect. Treatment of the urge component with antimuscarinics is effective; however, the stress component is likely to persist after therapy. Treatment with vaginal estrogen cream may help in the short-term, but long-term benefits are unknown. Anti-incontinence surgery may have a positive impact on both the stress and urge components of MUI; however, it appears that women with MUI may have lower cure rates compared to women with pure stress urinary incontinence. SUMMARY: The optimum treatment of MUI may often require multiple treatment modalities. Although surgery may often have a positive impact on both components, its routine implementation should be approached with caution and patients should be carefully selected and counseled.

Impact of convenience void in a bladder diary with urinary perception grade to assess overactive bladder symptoms: a community-based study.

AIM: Bladder diaries including bladder perception grade were analyzed to assess convenience void (CV) in community-dwelling women 40 years of age or older. METHODS: A total of 310 women completed a 3-day bladder diary with a grade for bladder perception. The grade was defined on scores 0-5 as follows: 0 = No bladder sensation, 1 = Sensation of bladder filling without desire to void, 2 = Desire to void, 3 = Strong desire to void, 4 = Urgency without urge urinary incontinence (UUI), and 5 = Urge incontinence episode. CV was defined as void without desire to void: when the grade was 0, CV in a narrow sense, and when 0 or 1, CV in a broad sense. RESULTS: The incidence of CV in the broad sense significantly decreased with age. Of the 310 women, 48 (15.5%) had overactive bladder (OAB) symptoms on the medical interview, including 37 (11.9%) without UUI (OAB-Dry) and 11 (3.5%) with UUI (OAB-Wet). Of the remaining 262 women, 111 (35.8%), who had urgency but a urinary frequency of 7 or less, and another 141 (48.7%) were classified into the Normal with Urgency and Normal without Urgency groups, respectively. The incidence of CV in a broad sense in the Normal without Urgency group was significantly greater than that in the Normal with Urgency and OAB-Wet groups. The mean voided volumes of CV in the broad sense in the OAB-Wet group were significantly smaller than those in the other three groups. CONCLUSIONS: The evaluation of CV may be a new tool in assessing storage condition and voiding dysfunction.

Urinary incontinence is associated with lower psychological general well-being in community-dwelling women.

OBJECTIVE: There are few studies documenting the impact of urinary incontinence (UI) on well-being in women. The aim of this study was to evaluate the relationships between different types of UI and general well-being in women in the community. METHODS: A cross-sectional survey of 542 community-dwelling women, aged 24 to 80 years, was conducted in July 2006. A detailed self-administered questionnaire was mailed to the study participants. UI was assessed using the Questionnaire for Urinary Incontinence Diagnosis, and well-being was assessed using the Psychological General Well-being Index (PGWBI). The relationships between types of UI and PGWBI scores were assessed using multiple regression analyses while adjusting for potential confounders. RESULTS: A total of 506 (94%) women provided data for analysis. Women with incontinence had a lower total PGWBI score (76.9 +/- 16.5) than did women with no UI (81.6 +/- 15.3; P = 0.001). The total PGWBI mean score was significantly lower in women with stress-only UI (77.8 +/- 16.2; P = 0.05) and mixed UI (74.2 +/- 17.8; P < 0.001) compared with women with no UI. There was no significant difference in the mean total scores between women with urge UI and women without UI. Stress-only UI was negatively associated with the PGWBI subdomains of self-control, general health, and vitality, whereas those with mixed UI had lower scores for all the PGWBI subdomains. The associations for UI remained significant after adjustment for age, systemic hormone therapy use, menopause status, smoking status, and regular exercise. CONCLUSIONS: Not only is UI associated with a significant reduction in well-being in community-dwelling women, but also, the relationship between different types of UI and well-being seems to differ.

Treatment success for overactive bladder with urinary urge incontinence refractory to oral antimuscarinics: a review of published evidence.

BACKGROUND: Treatment options for overactive bladder (OAB) with urinary urge incontinence (UUI) refractory to oral antimuscarinics include: botulinum toxin type A (BoNTA), sacral neuromodulation (SNM), and augmentation cystoplasty (AC). A standard treatment success metric that can be used in both clinical and economic evaluations of the above interventions has not emerged. Our objective was to conduct a literature review and synthesis of published measures of treatment success for OAB with UUI interventions and to identify a treatment success outcome. METHODS: We performed a literature review of primary studies that used a definition of treatment success in the OAB with UUI population receiving BoNTA, SNM, or AC. The recommended success outcome was compared to generic and disease-specific health-related quality-of-life (HRQoL) measures using data from a BoNTA treatment study of neurogenic incontinent patients. RESULTS: Across all interventions, success outcomes included: complete continence (n = 23, 44%), > or = 50% improvement in incontinence episodes (n = 16, 31%), and subjective improvement (n = 13, 25%). We recommend the OAB with UUI treatment success outcome of > or = 50% improvement in incontinence episodes from baseline. Using data from a neurogenic BoNTA treatment study, the average change in the Incontinence Quality of Life questionnaire was 8.8 (95% CI: -4.7, 22.3) higher for those that succeeded (N = 25) versus those that failed (N = 26). The average change in the SF-6D preference score was 0.07 (95% CI: 0.02, 0.12) higher for those that succeeded versus those that failed. CONCLUSION: A treatment success definition that encompasses the many components of underlying OAB with UUI symptoms is currently not practical as a consequence of difficulties in measuring urgency. The treatment success outcome of > or = 50% improvement in incontinence episodes was associated with a clinically meaningful improvement in disease-specific HRQoL for those with neurogenic OAB with UUI. The recommended success definition is less restrictive than a measure such as complete continence but includes patients who are satisfied with treatment and experience meaningful improvement in symptoms. A standardized measure of treatment success will be useful in clinical and health economic applications.

How sudden is a compelling desire to void? An observational cystometric study on the suddenness of this sensation.

OBJECTIVE: To evaluate whether a compelling desire to void (CDV) is always perceived suddenly, or whether it can result from the gradual build-up of bladder-filling sensations. PATIENTS AND METHODS: The pattern of filling sensations was evaluated during standard cystometric bladder filling in 75 patients who complained of urgency and showed detrusor overactivity during cystometry. Cystometric filling ended when a CDV was reported. The 'warning volume' is defined as the difference in volume between the first perception of filling and the volume at CDV. RESULTS: Different patterns of bladder-filling sensations were reported. A CDV occurred suddenly, without a preceding sensation in 13% of the patients, whereas 66% reported at least two normal preceding filling sensations before a CDV. The bladder volume at the CDV was significantly smaller in patients that reported no or just one preceding sensation compared with those that reported the normal pattern of two or three sensations (P < 0.005). The bladder volume at which the first filling perception was reported was not different regardless of whether it was described as a first sensation of filling, a first desire or a CDV (P = 0.42). The warning volumes were not different between patients with one or no standardized filling sensations (P = 0.7), but they were significantly smaller than in patients with two or three filling sensations (P = 0.85). CONCLUSION: A CDV can occur suddenly if normal filling sensation is disturbed, but also gradually if normal filling sensation is preserved. In cases of disturbed filling sensation, the volume at CDV and the warning volume are significantly lower.

Voiding urges perceived by patients with interstitial cystitis/painful bladder syndrome.

AIMS: Interstitial cystitis/painful bladder syndrome (IC/PBS) is a symptom-based diagnosis. We studied the IC/PBS symptom commonly referred to as "urgency" and its relationship to IC/PBS pain in a group of women with recent onset of the disease. METHODS: As part of a case control study to identify risk factors for IC, cases completed a questionnaire including two statements regarding the perceived cause of their urge to void. One was related to fear of incontinence and the other was linked with relief of pain. A Likert scale indicating level of agreement/disagreement comprised the response options. RESULTS: Most respondents (65%) agreed with the statement linking urge with pain relief. A minority (21%) concurred with the fear of incontinence statement. Disagreement for both was found in 19%. A substantial proportion (46%) agreed with pain relief but also disagreed that urge is related to fear of incontinence. Those who reported urge to relieve pain were significantly more likely to report worsened pain with bladder filling and/or improved pain with voiding. There were no such associations with urge to prevent incontinence. Overactive bladder or diabetes prior to IC onset did not confound these results. CONCLUSIONS: At least two distinct experiences of urge to urinate are evident in this population. For most, urge is linked with pain relief and is associated with bladder filling/emptying. About 1/5 reported urge to prevent incontinence. A similar portion did not agree with either urge, indicating that they may experience something altogether different, which requires further inquiry.

Safety and efficacy of tolterodine extended release in men with overactive bladder symptoms and presumed non-obstructive benign prostatic hyperplasia.

Patients with presumed non-obstructive BPH (Q (max )>or= 15 ml/s) treated with tolterodine ER 4 mg/day for OAB symptoms, alone or added to unsuccessful alpha-blocker treatment of >or=6 weeks duration, were observed for 12 weeks in a non-interventional study to generate real-life efficacy and safety data. Patients completed the IPSS, the OAB-q and a 2-day micturition diary at baseline and 12 weeks. PVR was determined sonographically. Seven hundred and forty one patients were analysed. Mean PVR did not increase (25.4 +/- 26.5 vs. 29.3 +/- 30.9 ml at baseline). AUR requiring catheterization occurred in two patients, acute UTI in four patients. Median IPSS total scores decreased from 17 to 10, IPSS QoL scores from 4 to 2, OAB-q symptom bother scores from 50.0 to 22.5 and OAB-q HRQL scores increased from 59.2 to 81.6. In men with OAB symptoms and presumed non-obstructive BPH, tolterodine ER provided considerable symptomatic and QoL improvements with a low risk of AUR, acute UTI, or increased PVR.

Correlations between the ICIQ-SF score and urodynamic findings.

AIMS: The primary aim of this prospective study was to examine the correlations between "The International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF)" score and urodynamic findings in patients with urge incontinence. In addition, we aimed to observe the alterations of these parameters with antimuscarinic therapy. METHODS: Between January and December 2005, patients referred to our department with urge incontinence were examined. After taking a detailed clinical history, physical examination, and urinalysis, each patient was asked to complete an ICIQ-SF questionnaire. We carried out subtracted cystometry according to a fixed protocol on all patients. Patients who were defined as detrusor overactivity incontinent were given antimuscarinic therapy for 3 months. Following treatment, filling cystometry and ICIQ-SF scoring were repeated in all patients. All pre- and post-treatment data of 18 male and 42 female patients were transferred to the SPSS 11.0 for Windows program, and statistical analyses were performed. RESULTS: The patients' ages ranged from 28 to 70 (mean 49.8) years. We found statistically significant differences between the pre- and post-treatment parameters (mean ICIQ-SF score, first sensation, cystometric capacity, maximum detrusor pressure, compliance; P<0.01). We found negative correlation between pre-treatment mean ICIQ-SF score and first sensation (correlation coefficient -0.266, P<0.05) and positive correlation between pre-treatment mean ICIQ-SF score and maximum detrusor pressure (correlation coefficient 0.4, P<0.01). CONCLUSIONS: ICIQ-SF scoring is a practical and reliable method for baseline and post-treatment evaluation of patients with urge incontinence. Significant correlation exists between ICIQ-SF score and urodynamic parameters.

Quality of life in women with stress urinary incontinence.

The objective of this study was to identify clinical and demographic factors associated with incontinence-related quality of life (QoL) in 655 women with stress urinary incontinence who elected surgical treatment. The following factors were examined for their association with QoL as measured with the Incontinence Impact Questionnaire (IIQ): number of incontinence (UI) episodes/day; self-reported type of UI symptoms (stress and urge); sexual function as measured by the Prolapse/Urinary Incontinence Sexual Questionnaire; symptom bother as measured by the Urogenital Distress Inventory; as well as other clinical and sociodemographic factors. A stepwise least-squares regression analysis was used to identify factors significantly associated with QoL. Lower QoL was related to the greater frequency of stress UI symptoms, increasing severity, greater symptom bother, prior UI surgery or treatment, and sexual dysfunction (if sexually active). Health and sociodemographic factors associated with lower incontinence-related QoL included current tobacco use, younger age, lower socioeconomic status, and Hispanic ethnicity.