Quality of life following transobturator sling surgery for female stress urinary incontinence.

OBJECTIVE: This descriptive study examines quality of life in women undergoing placement of a midurethral sling for stress urinary incontinence. MATERIALS AND METHODS: This was a retrospective cohort study based on data from 51 women consecutively undergoing this procedure at a tertiary hospital in the years 2014 and 2015. The main outcome variable was quality of life assessed through the Sandvick severity test and International Consultation on Incontinence Short Quality of Life Questionnaire (ICIQ-IU-SF) at the time points baseline or presurgery, and 6 months and 5 years postsurgery. Factors associated with treatment failure were determined through binary logistic regression. RESULTS: At 5-year follow up we obtained an absolute reduction of 8.78 points (95% CI 6.43-11.14; p < 0.001) in the ICIQ-IU-SF questionnaire and 4.54 (95% CI 3.25-5.83; p < 0.001) in the Sandvick severity test score, compared to baseline, in the 35 patients that completed follow-up. Out of the 51 patients that were followed, the rate of success in incontinence correction was 86.3% (44/50) with a failure rate of 12% (6/50). Multiparity and previous gynaecological surgery were identified as predisposing factors for treatment failure. Obesity was associated with a worse treatment outcome. CONCLUSION: Sling treatment for incontinence was successful in 86.3% (44/50) of participants and remained effective 5 years after surgery in terms of quality of life.

Safety and Efficacy of Erbium: Yttrium-Aluminum-Garnet Laser Treatment in Chinese Women with Mild-to-Moderate Stress Urinary Incontinence.

Background: This study aims to evaluate the safety and efficacy of erbium:yttrium-aluminum-garnet (Er:YAG) laser treatment in female patients with mild-to-moderate stress urinary incontinence (SUI). Methods: From July 2018 to June 2020, 72 female patients with mild-to-moderate SUI were enrolled in this study. A baseline assessment was conducted, which included a 1-hour pad test, the validated International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI-SF), postvoid residual (PVR) testing, pelvic organ prolapse quantification (POP-Q) testing, and a cough stress test. All patients underwent four sessions of Er:YAG laser treatment using a smooth mode. A reassessment was performed 6 months after treatment to evaluate the safety and efficacy of the Er:YAG laser. Results: All patients completed four clinic visits, with a 1-month interval, and were followed up for a minimum of 6 months. No severe adverse reactions were observed during the treatment process. The 1-hour pad test revealed a significant reduction in urinary leakage from baseline (6.30 ± 1.06 g) to the 6-month follow-up (2.70 ± 0.96 g, p < 0.001), with 34 of 72 (47.22%) patients achieving negative results. The ICIQ-UI-SF score significantly decreased from baseline to 6 months (10.82 ± 1.38 to 2.96 ± 0.52, p < 0.001). PVR experimental results showed a significant decrease in residual urine volume after treatment (103.72 ± 8.61 mL to 43.86 ± 4.92 mL, p < 0.001). At the 6-month follow-up, hematoxylin and eosin staining results demonstrated that Er:YAG laser treatment significantly facilitated an increase in the thickness of squamous epithelial cells. The efficacy of Er:YAG laser treatment for SUI was 77.78% (56/72). Conclusions: Several objective and subjective assessments confirmed the safety and efficacy of vaginal smooth mode Er:YAG laser treatment for mild-to-moderate SUI during the 6-month follow-up period. Nonablative Er:YAG laser in the smooth mode is a viable treatment option for SUI patients.

Tamoxifen or aromatase inhibitors: which one is the culprit of urinary incontinence in premenopausal breast cancer patients receiving adjuvant hormone therapy?

AIM: The primary aim of this study was to compare tamoxifen versus aromatase inhibitors (AI) in terms of urinary incontinence (UI) in premenopausal female patients receiving adjuvant hormone therapy for breast cancer. A secondary aim was to investigate the prevalence and the affecting factors of UI. METHODS: This study was designed as a multicenter, cross-sectional that included consecutive premenopausal breast cancer patients ≤50 years of age receiving tamoxifen (with/without LHRHa) or AI (with LHRHa) for at least 6 months, between June 2021 and September 2022. Patients with urinary incontinence before hormone treatments and metastatic patients were excluded from the study. Turkish validation of The International Consultation on Incontinence Modular Questionnaire Urinary Incontinence Short Form (ICIQ UI-SF) was used to determine the UI. Using logistic regression methods, we analyzed potential predictive factors for UI. RESULTS: A total of 206 breast cancer patients were included in this study. A total of 120 (58.2%) patients were receiving tamoxifen plus LHRHa, 40 (19.4%) patients were receiving aromatase inhibitor plus LHRHa, and 46 (22.3%) patients were receiving tamoxifen only. In this study, the prevalence of urinary incontinence was found to be 35.9% (n:74). 41% of the patients receiving tamoxifen and 15.0% of those receiving aromatase inhibitors had complaints of urinary incontinence. There was a statistically significant difference between patients receiving tamoxifen or aromatase inhibitor in terms of urinary incontinence (p=0.001). In the univariate analysis established to predict UI, parity (≥2 vs <2) (OR = 3.23, 95% CI: 1.62-6.46, p= 0.001), tamoxifen (vs AI) (OR = 3.97, 95% CI: 1.58-9.98, p= 0.003), age ( ≥40 vs. <40) (OR = 2.80, 95% CI: 1.37-5.71, p= 0.005), vaginal deliveries (≥2 vs. <2) (OR = 3.28, 95% CI: 1.44-7.46, p= 0.005), hypertension (OR = 3.59, 95% CI: 1.43-9.02, p= 0.007), diuretic use (OR = 2.55, 95% CI: 1.09-5.95, p= 0.031) ), and body mass index (≥25 vs <25) (OR = 1.94, 95% CI: 1.05-3.63), p= 0.034) was found to be predictive. Tamoxifen (OR = 4.71, 95% CI: 1.77-12.56, p= 0.002), hypertension (OR = 3.48, 95% CI: 1.27-9.52, p= 0.015), and age (OR = 2.35, 95% CI: 1.10-5.02, p= 0.027) remained independent predictors for incontinence in multivariate analyses. CONCLUSION: We found that tamoxifen had increased the risk of urinary incontinence compared to aromatase inhibitors in patients receiving hormone therapy for breast cancer. In addition, we showed that age and hypertension were also independent predictors for UI. In the context of quality of life, we recommend close follow-up of these patients, as drug adherence may be affected in the event of urinary incontinence.

Proper understanding of recurrent stress urinary incontinence treatment in women (PURSUIT): a randomised controlled trial of endoscopic and surgical treatment.

BACKGROUND: Women with stress urinary incontinence (SUI) experience urine leakage with physical activity. Currently, the interventional treatments for SUI are surgical, or endoscopic bulking injection(s). However, these procedures are not always successful, and symptoms can persist or come back after treatment, categorised as recurrent SUI. There are longstanding symptoms and distress associated with a failed primary treatment, and currently, there is no consensus on how best to treat women with recurrent, or persistent, SUI. METHODS: A two-arm trial, set in at least 20 National Health Service (NHS) urology and urogynaecology referral units in the UK, randomising 250 adult women with recurrent or persistent SUI 1:1 to receive either an endoscopic intervention (endoscopic bulking injections) or a standard NHS surgical intervention, currently colposuspension, autologous fascial sling or artificial urinary sphincter. The aim of the trial is to determine whether surgical treatment is superior to endoscopic bulking injections in terms of symptom severity at 1 year after randomisation. This primary outcome will be measured using the patient-reported International Consultation on Incontinence Questionnaire - Urinary Incontinence - Short Form (ICIQ-UI-SF). Secondary outcomes include assessment of longer-term clinical impact, improvement of symptoms, safety, operative assessments, sexual function, cost-effectiveness and an evaluation of patients' and clinicians' views and experiences of the interventions. DISCUSSION: There is a lack of high-quality, randomised, scientific evidence for which treatment is best for women presenting with recurrent SUI. The PURSUIT study will benefit healthcare professionals and patients and provide robust evidence to guide further treatment and improve symptoms and quality of life for women with this condition. TRIAL REGISTRATION: International Standard Randomised Controlled Trials Number (ISRCTN) registry ISRCTN12201059. Registered on 09 January 2020.

Assessment of the Relative Performance of the EQ-5D-3L, ICIQ-UI SF and POP-SS Using Data from the OPAL Trial.

Conducting economic evaluations alongside randomised controlled trials (RCTs) is an efficient way to collect cost-effectiveness data. Generic preference-based measures, such as EQ-5D, are often used alongside clinical data measures in RCTs. However, in the case of female urinary incontinence (UI), evidence of the relative performance of EQ-5D with condition-specific measures such as the International Consultation on Incontinence Questionnaire Urinary Incontinence Short Form (ICIQ-UI SF), measuring severity of UI, and Pelvic Organ Prolapse Symptom Score (POP-SS), measuring severity of prolapse symptoms, is limited. This study employed secondary analysis of outcome measures data collected during the Optimal Pelvic floor muscle training for Adherence Long-term (OPAL) RCT, which compared biofeedback-mediated pelvic floor muscle training to basic pelvic floor muscle training for women with UI. The relative performance of EQ-5D-3L and ICIQ-UI SF, and EQ-5D-3L and POP-SS was assessed for concurrent validity and known-groups validity. Data for 577 women (mean age 48) were available for EQ-5D-3L/ICIQ-UI SF, and 555 women (mean age 47) for EQ-5D-3L/POP-SS. Overall, EQ-5D-3L exhibited very weak association with the ICIQ-UI SF total score, or any subscale. EQ-5D-3L and POP-SS were found to be weakly correlated. EQ-5D-3L was able to distinguish between groups with known differences in severity of UI and also between types of UI. These findings provide useful information to guide researchers in selecting appropriate outcome measures for use in future clinical trials.

Impact of bariatric surgery on urinary incontinence in morbidly obese individuals.

BACKGROUND: There is scanty evidence on the impact of bariatric surgery on urinary incontinence (UI) in the Asian population. METHODOLOGY: Patients who underwent bariatric surgery from June 2018 to June 2019 were screened using the International Consultation on Incontinence Questionnaire-Urinary Incontinence-Short Form (ICIQ-UI-SF) questionnaire. Patients having UI were identified and followed until 1 year of surgery using the ICIQ-UI-SF. These were classified as having stress, urge, or mixed type of UI. The prevalence, change in scores, and the number of pads used were compared at baseline and at follow-up. RESULTS: A total of 148 patients underwent bariatric surgery of whom, 41 patients (M = 2, F = 39) had UI. Stress incontinence was seen in 70.7%, 19.5% had urge incontinence, and rest had the mixed type. Using logistic regression, it was found that female gender was the most important predictor of having UI (OR: 8.33). The prevalence of UI decreased from 27.7% at baseline to 8.1% at 6 months and 3.4% at 12 months. The mean ICIQ-UI-SF score improved from 8.76 (SD = 3.2) at baseline to 0.66 (SD = 2.1) at 12 months of follow-up. The proportion of patients with UI using any number of pads decreased from 92.7% at baseline to 9.8% at 12 months. There was a decrease in the number of patients having moderate to very severe UI from 35 (85.4%) at baseline to 2 (4.9%) at 12 months. Proportion of patients showing resolution was highest among the stress incontinence group at 96.5%. Presence or absence of comorbidities did not significantly influence the ICIQ-UI-SF scores. CONCLUSION: Bariatric surgery leads to profound improvement in UI in obese individuals which is well sustained until 1 year of follow-up. Resolution rates might be higher in Asian population.

Quality of life in women with urinary incontinence seeking care using e-health.

BACKGROUND: Quality of life (QoL) in women with urinary incontinence (UI) is mainly affected by UI severity, but it is also affected by the UI subtype, comorbidities, age, and socioeconomic status. e-Health is a new method for providing UI treatment. This study aimed to identify factors with the highest impact on QoL in women that turned to e-health for UI self-management. METHODS: We analysed data from three randomized controlled trials (RCTs) that evaluated e-health treatments for UI. We included baseline data for 373 women with stress urinary incontinence (SUI) and 123 women with urgency/mixed UI (UUI/MUI). All participants were recruited online, with no face-to-face contact. Participants completed two questionnaires: the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF, range: 0-21 points), for assessing UI severity, and the ICIQ Lower Urinary Tract Symptoms Quality of Life (ICIQ-LUTSqol, range: 19-76 points), for assessing condition-specific quality of life (QoL). To identify factors that impacted QoL, we constructed a linear regression model. RESULTS: The mean ICIQ-LUTSqol score was 34.9 (SD 7.6). UI severity significantly affected QoL; the adjusted mean ICIQ-LUTSqol score increased by 1.5 points for each 1.0-point increase in the overall ICIQ-UI SF score (p < 0.001). The UI type also significantly affected QoL; the adjusted mean ICIQ-LUTSqol score was 2.5 points higher in women with UUI/MUI compared to those with SUI (p < 0.001). CONCLUSIONS: We found that women that turned to e-health for UI self-management advice had a reduced QoL, as shown previously among women seeking UI care through conventional avenues, and that the severity of leakage had a greater impact on QoL than the type of UI. Condition-specific factors impacted the QoL slightly less among women that turned to e-health, compared to women that sought help in ordinary care. Thus, e-health might have reached a new group of women in need of UI treatment.

[Effect of moxibustion on postpartum urodynamics and pelvic floor function in puerperal women].

OBJECTIVE: To observe the effect of moxibustion on postpartum urodynamics and recovery of pelvic floor function based on the pelvic floor muscle function training. METHODS: A total of 150 puerperal women were randomly divided into an observation group (75 cases, 15 cases dropped off) and a control group (75 cases, 15 cases dropped off). The control group was treated with pelvic floor muscle function training, twice a day. Based on the treatment in the control group, the observation group was treated with Baixiao moxibustion at Qihai (CV 6), Guanyuan (CV 4), Sanyinjiao (SP 6) and Zusanli (ST 36), twice a week. The treatment started on the 42nd day after delivery, totaling for 12 weeks. The urodynamic indexes (functional urethral length [FUL], stress leak point pressure [SLPP], maximum urethral closure pressure [MUCP], bladder compliance [BC], maximum urethral pressure [MUP], detrusor pressure at maximum urinary flow rate [Pdet Qmax]), the international consultation on incontinence questionnaire-urinary incontinence-short form (ICIQ-UI-SF) score and vaginal muscle voltage were observed before and after treatment. The prolapse rate of pelvic floor organ and normal rate of pelvic floor muscle strength of the two groups were recorded after treatment. RESULTS: Compared before treatment, the levels of FUL, MUCP, BC, Pdet Qmax and SLPP in the observation group after treatment were increased (P<0.05), while the FUL and SLPP in the control group after treatment were increased (P<0.05). After treatment, the levels of FUL, SLPP, MUCP and BC in the observation group were higher than those in the control group (P<0.05). Compared before treatment, the ICIQ-UI-SF scores in the two groups after treatment were decreased (P<0.01), and the vaginal muscle voltage was increased (P<0.01). After treatment, the ICIQ-UI-SF score in the observation group was lower than that in the control group (P<0.01), and the vaginal muscle voltage in the observation group was higher than that in the control group (P<0.01). The prolapse rate of pelvic floor organ was 6.7% (4/60) in the observation group, which was lower than 20.0% (12/60) in the control group (P<0.05). The normal rate of pelvic floor muscle strength in the observation group was 88.3% (53/60), which was higher than 65.0% (39/60) in the control group (P<0.05). CONCLUSION: The moxibustion combined with pelvic floor muscle function training could improve postpartum urodynamics and pelvic floor muscle strength.

Complications and re-operations after tension-free vaginal tape operation in women with stress urinary incontinence.

INTRODUCTION AND HYPOTHESIS: We evaluate intraoperative and short-term postoperative (≤ 3 months) complications and long-term re-operations (up to 6 years) after tension-free vaginal tape (TVT) operation in women with stress urinary incontinence (SUI). METHODS: Data from 446 women undergoing TVT operation between 2012 and 2016 at a tertiary referral center was retrospectively collected. Data included patient baseline demographics, information from the TVT operation and the following postoperative period, and scores from patient questionnaires [the International Consultation of Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) and Patient Global Impression of Improvement (PGI-I)]. Collected data were investigated for incidence of complications and re-operations, postoperative improvement in patient questionnaires, and association between complications and baseline patient demographics. RESULTS: The only intraoperative complication was bladder perforation (2.0%). Postoperative complications included: infection (0.7%), hematoma (0.9%), bleeding (0.2%), pain (0.9%), erosion of the vaginal mucosa (1.1%), persistent SUI (0.7%), and voiding dysfunction > 24 h (10.3%). Re-operations included: operation due to infections (0.4%), incontinence surgery for persistent SUI (0.4%), revision for tape erosion (1.1%), tape mobilization (3.6%), and tape division (0.2%). A significant reduction in urinary incontinence symptoms was observed in the ICIQ-UI SF and PGI-I. The reduction in ICIQ-UI SF did not vary significantly between patients with and without complications. No association between complications and baseline patient demographics was found. CONCLUSION: This study demonstrated high safety and efficacy of the TVT operation with only minor short-term complications and few long-term re-operations. The ICIQ-UI SF improved significantly postoperatively and was not statistically significantly affected by the occurrence of complications.

Effect of moxibustion on postpartum urodynamics and pelvic floor function in puerperal women / 中国针灸

OBJECTIVE@#To observe the effect of moxibustion on postpartum urodynamics and recovery of pelvic floor function based on the pelvic floor muscle function training.@*METHODS@#A total of 150 puerperal women were randomly divided into an observation group (75 cases, 15 cases dropped off) and a control group (75 cases, 15 cases dropped off). The control group was treated with pelvic floor muscle function training, twice a day. Based on the treatment in the control group, the observation group was treated with @*RESULTS@#Compared before treatment, the levels of FUL, MUCP, BC, Pdet Qmax and SLPP in the observation group after treatment were increased (@*CONCLUSION@#The moxibustion combined with pelvic floor muscle function training could improve postpartum urodynamics and pelvic floor muscle strength.

Validation of the UDI-6 and the ICIQ-UI SF - Croatian version.

INTRODUCTION AND HYPOTHESIS: Despite the widespread use of UDI-6 and ICIQ-UI SF in Croatia, it remains unknown whether a realiable and valid measure for the population of interest is used. Thus, the aim of this study was to translate, adapt and validate the UDI-6 and the ICIQ-UI SF in Croatia. METHODS: The study included a total of 232 consecutive patients with urinary incontinence symptoms. The translation to Croatian followed standardized procedure. All participants underwent urodynamic assesment and completed UDI-6 and ICIQ-UI SF questionnaires at inclusion and 2 weeks after to assess test-retest reliability. Cronbach α coefficient was calculated in order to assess internal consistency. RESULTS: Both questionnaires had high internal consistency (Cronbach α for UDI-6 and ICIQ-UI SF was .83 and .85, respectively) and high test-retest reliability (intraclass correlation coefficient .99 for instruments). Strong correlation was found between urodynamic findings and total scores in UDI-6 and ICIQ-UI SF (ρ = 0.88 and 0.89, respectively). Women with stress urinary incontinence (SUI) and detrusor overactivity (DOA) group had significantly higher scores on UDI-6 (Mdn = 33.33 and Mdn = 50, respectively) compared to women with no urodynamic abnormality (Mdn = 0; p < 0.001). Women with no urodynamic abnormality scored significantly lower on ICIQ-UI SF (Mdn = 0; p < 0.001) compared to women with SUI (Mdn = 14) and DOA (Mdn = 16). Women with DOA scored worse on Irritative and Obstructive symptoms when comparing with two other groups (p < 0.001), while women with SUI had significantly worse score on Stress symptoms subscale (p < 0.001). CONCLUSIONS: The UDI-6 and ICIQ-UI SF have very good psychometric characteristics and can be used in Croatian urogynecology practice.

Benchmarking outcomes in maternity care: Peripartum incontinence - a framework for standardised reporting.

OBJECTIVE: To evaluate a framework to facilitate standardised reporting of perinatal incontinence. DESIGN: An exploratory, prospective, observational cohort study. SETTING: One Australian tertiary maternity referral centre. PARTICIPANTS: Data from 309 pregnant women collected between August 2017 and January 2019. MEASUREMENTS AND FINDINGS: A framework was developed using consensus-based terminology and definitions, measures and data-collection time-points. The ICIQ-UI SF and the Wexner Scale were administered during pregnancy (<27 and 36-weeks) and postpartum (6- and 26-weeks). Incidence, trajectory and group differences for urinary incontinence subcategories were evaluated. Stress urinary incontinence was the largest contributor of urinary incontinence during pregnancy (39.2%) followed by mixed (11.3%) and urgency incontinence (7.4%). Factors associated with incontinence subcategories during pregnancy were multiparity (stress: RR 1.74), co-existing anal incontinence (mixed: RR 3.51) and early pregnancy urinary incontinence (stress: RR 2.79; mixed: RR 2.85). Factors postpartum included primiparity (urgency), vaginal birth (stress), induction of labour (stress: RR 2.99; urgency: RR 0.2), waterbirth (urgency: RR 2.66), coexisting anal incontinence (urgency: RR 3.55) and late pregnancy urinary incontinence (mixed: RR 3.97). Low numbers of women with anal incontinence prohibited subcategory analysis. KEY CONCLUSIONS: Findings offer preliminary support for the effectiveness of the framework for the measurement and reporting of urinary incontinence in childbearing women. Future research is needed to evaluate the framework in larger and more diverse maternity populations. IMPLICATIONS FOR PRACTICE: A framework for standardised measurement and reporting of perinatal incontinence will facilitate improved synthesis of research findings with the potential to improve the quality of evidence-based clinical guidelines.

Erbium:YAG laser treatment of female stress urinary incontinence: midterm data.

INTRODUCTION AND HYPOTHESIS: Stress urinary incontinence (SUI) is treated using intravaginal laser therapy. We wanted to find out how incontinence severity at baseline and the number of laser interventions affect success rate, and whether the effect of laser therapy was obvious 6 months and 2 years after the last laser intervention. METHODS: Fifty-nine women, 32 with SUI I, 16 with SUI II, and 11 with SUI III were treated using an erbium-doped yttrium aluminium garnet (Er:YAG) laser following the IncontiLase® protocol. Therapy included five laser sessions with a 1-month interval between sessions. Objective (1-h pad test) and subjective data (International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form [ICIQ-UI SF], Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire [PISQ-12]) were assessed at baseline, after two and four laser sessions and 6 months and 2 years after the fifth laser session. RESULTS: Objective cure/improve rates for mild SUI I were 69%, 78%, 91%, and 78% after two, four, and five laser sessions at the 6-month and 2-year follow-ups. Subjective cure rates (ICIQ-UI SF) were 53%, 69%, 72%, and 66%, and sexual function (PISQ-12) also improved. For SUI II, objective cure/improve rates were 31%, 63%, 69%, and 50%. Subjective cure rate was 13% at the 2-year follow-up. For SUI III, only one patient had an objective improvement after two and four laser sessions. CONCLUSIONS: Intravaginal laser therapy led to cure/improvement for SUI I and SUI II, but not for severe SUI III. Outcome was better after four to five laser sessions than after two laser sessions. Follow-up data 6 months and 2 years after laser intervention showed sustainability of the treatment.

Perinatal incontinence: Psychometric evaluation of the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form and Wexner Scale.

AIM: The International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) and the Wexner Scale have been included in the International Consortium for Health Outcomes Measurement core outcome set during pregnancy and childbirth, to measure urinary and anal incontinence. The reliability and validity of these instruments have not been fully evaluated in maternity populations. The aim of this study was to conduct a psychometric evaluation of the ICIQ-UI SF and Wexner Scale. METHODS: Consecutive pregnant women (n = 309) who booked for care at one Australian birth facility between August 2017 and April 2018 completed the online surveys. Women who screened positive for urinary and/or anal incontinence were administered the ICIQ-UI SF and/or Wexner Scale during pregnancy ( <27 and 36-weeks) and postpartum (6 and 26-weeks). Scale internal consistency, construct validity, and responsiveness were evaluated. FINDINGS: In women with urinary incontinence, the ICIQ-UI SF demonstrated good internal consistency during pregnancy (baseline and 36 weeks) and 6-weeks postpartum (mean inter-item correlation: 0.47, 0.39, and 0.46, respectively), recorded significant change across three time-points, and was sensitive to group differences in age and obesity during pregnancy. Wexner Scale was unsuitable for psychometric analysis due to insufficient numbers of women with anal incontinence. CONCLUSION: The ICIQ-UI SF is a valid and reliable instrument to measure urinary incontinence during pregnancy and postpartum. The findings support the inclusion of the ICIQ-UI SF in the International Consortium for Health Outcomes Measurement core outcome set for use during the perinatal period. Psychometric analysis of the Wexner Scale in larger maternity populations is recommended.

Measuring quality of life in patients with stress urinary incontinence: is the ICIQ-UI-SF adequate?

PURPOSE: The International Consultation on Incontinence Questionnaire Short Form (ICIQ-UI-SF) is a widely used four-item patient-reported outcome (PRO) measure. Evaluations of this instrument are limited, restraining user's confidence in the instrument. This study conducts a comprehensive evaluation of the ICIQ-UI-SF on a sample of urological surgery patients in Canada. METHODS: One hundred and seventy-seven surgical patients with stress urinary incontinence completed the ICIQ-UI-SF pre-operatively. Methods drawing from confirmatory factor analysis (CFA), measures of reliability, item response theory (IRT), and differential item functioning were applied. Ceiling effects were examined. RESULTS: Ceiling effects were identified. In the CFA, the factor loadings of items one and two differed significantly (p < 0.001) from item three indicating possible multidimensionality. The first two items reflect symptom severity not quality of life. Reliability was moderate as measured by Cronbach's alpha (0.63) and McDonald's coefficient (0.65). The IRT found the instrument does not discriminate between individuals with low incontinence-related quality of life. CONCLUSIONS: Due to low/moderate reliability, the ICIQ-UI-SF can be used as a complement to other data or used to report aggregated surgical outcomes among surgical patients. If the primary objective is to measure quality of life, other PROs should be considered.

Screening for urinary incontinence in acute care for elders unit: comparative performance analysis of Katz's ADL and ICIQ-UI-SF.

BACKGROUND: Urinary incontinence (UI) is a frequent, but neglected geriatric syndrome, particularly in vulnerable older patients. Optimizing screening procedures is necessary. OBJECTIVE: To compare the clinometric performances of the "continence" item of the Katz's ADL scale and the ICIQ-UI-sf for the screening of UI in vulnerable aged patients. METHODS: A prospective study was conducted in the acute care for elders (ACE) unit of an academic centre. Two independent nurses screened all patients with spontaneous urination for UI with Katz's ADL item and ICIQ-UI-sf upon the hospital admission. The diagnosis of UI resulted from an interdisciplinary conciliating meeting for urinary functional disorders (TOFU), gathering geriatricians and neuro-urologists and was considered as reference. RESULTS: 294 consecutive patients (mean age 86.2 ± 6.5 years; 76.5% female) admitted to the ACE unit were screened; 169 were incontinent (57.5%) according to TOFU. The Katz's ADL item identified 106 incontinent patients with 20 false positives; 83 incontinent patients were not identified. If the sensitivity and specificity of the ICIQ-UI-sf were 100.0%, they were, respectively, 50.9 and 84.0% for the Katz's ADL item. Positive and negative predictive values were 100.0% for ICIQ-UI-sf; 81.1 and 55.9% for ADL, respectively. CONCLUSION: This study validates the ICIQ-UI-sf as a simple and effective screening tool for UI in vulnerable and complex hospitalized aged patients. It also demonstrates that the "continence" item of the Katz's ADL scale is not sensitive enough for UI screening in this population.

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.

A populational-based survey on the prevalence, incidence, and risk factors of urinary incontinence in older adults-results from the "SABE STUDY".

AIMS: To estimate the prevalence and incidence of urinary incontinence (UI) and identify the associated risk factors in a cohort of elderly individuals in Brazil. METHODS: In 2006, individuals aged ≥60 years were selected from the SABE Study (Health, Well-being, and Aging). The dependent variable was reported UI in 2009. UI was assessed using the International Consultation on Incontinence Questionnaire Urinary Incontinence-Short Form (ICIQ-UI SF). Incidence was measured in units of 1000 person-years, and Cox regression was applied for data analysis. Multivariate analysis was used to assess risk factors for UI. Incidence risk ratio (IRR) was used for comparison. RESULTS: This is the first study to examine the incidence of UI in Brazilian elderly individuals. In total, 1413 individuals were included; the mean age was 74.5 years, and 864 (61.8%) participants were female. The risk of UI was greater among women with cancer (other than skin) and among those with diabetes. In men, the risk of UI was greater for those in Instrumental Activities of Daily Living (IADL) category "5-8" and those who self-reported a "fair" health status. The prevalence of UI was 14.2% and 28.2% for men and women, respectively. The incidence rate of UI was 25.6 and 39.3 (×1000 person-years) for men and women, respectively. CONCLUSIONS: The incidence rate of UI among older adults in the Brazilian community was high for elderly individuals. The identified risk factors were diabetes and IADL category 5-8 (women) as well as cancer (other than skin) and self-reported health status (male).

Clinical Observation of Moxibustion plus Pelvic Floor Muscle Exercises for Postpartum Stress Urinary Incontinence / 上海针灸杂志

Objective To compare the clinical efficacy among moxibustion plus pelvic floor muscle exercises, pelvic floor muscle exercises, and Western medication in treating postpartum stress urinary incontinence. Method Fifty-eight eligible patients were divided by the random number table into an integration group (19 cases), an exercise group (19 cases) and a Western medication group (20 cases). The integration group was intervened by pelvic floor muscle exercises plus moxibustion, 3 times of exercises a day, 5 min each time, and moxibustion at Zusanli (ST36), Sanyinjiao (SP6), Guanyuan (CV4), Zhongji (CV3) and Qihai (CV6), once a day, 30 min each session. The exercise group was intervened by muscle force exercises to train the pelvic floor muscle, 3 times a day, 5 min each time. The Western medication group was intervened by oral administration of Duloxetine hydrochloride, 80 mg a day (40 mg per dose, twice a day). For the above methods, 6 d was taken as a course of treatment. Four treatment courses were observed, with a 1-month follow-up study. The 1-hour pad test was used to record the volume of urine leak. Before and after the treatment, as well as in the 1-month follow-up, the International Consultation on Incontinence Questionnaire-Urinary Incontinence-Short Form (ICIQ-UI-SF) score was evaluated and compared among the groups, and the short-term and long-term therapeutic efficacies were also compared. Result The short-term and long-term therapeutic efficacies of the integration group were superior to those of the exercise group and Western medication group (P<0.05). The integration group showed significant improvement after the treatment and in the follow-up study compared to the pre-treatment state (P<0.01); after the intervention, the integration group was better than the exercise group and Western medication group in comparing the urine leak volume by the 1 h pad test and ICIQ-UI-SF score (P<0.01,P<0.05). Conclusion Moxibustion plus pelvic floor muscle exercises can improve the short-term quality of life of patients with postpartum stress urinary incontinence. This method can produce a better effect in improving the quality of life compared to pelvic floor muscle exercises alone.

Long-term functional outcomes after radical cystectomy with ileal bladder substitute: does the definition of continence matter?

OBJECTIVE: Functional outcomes after ileal bladder substitution reflect the expectations of future patients at a particular centre. The aim of this study was to use validated questionnaires and a pad-weighing test to investigate functional outcomes after neobladder reconstruction at long-term follow-up in patients at a single centre. MATERIALS AND METHODS: During 2005 - 2015, 75 patients received a Studer ileal bladder substitute at the Department of Urology, Malmö. Forty-six of these patients were alive for follow-up and were evaluated using the pad-weighing test and the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI-SF), the Female Sexual Function Index (FSFI) and the International Index of Erectile Function (IIEF). RESULTS: Five of 37 evaluable patients (14%) were considered fully continent, reporting a pad-weighing test result of 0 g and an ICIQ-UI-SF score of 0. The median ICIQ-UI-SF score was 8 [interquartile range (IQR) 3-11], and seven patients (17%) were continent according to the ICIQ-UI-SF score only. In the pad-weighing test, 28 out of 37 patients (76%) reported 0 g day-time leakage whereas only 12 out of 37 patients (32%) reported 0 g night-time leakage. At follow-up, nine out of 39 (23%) of evaluable male patients were potent. The median ICIQ-UI-SF score was significantly lower during the second half of the study period [4 (IQR 0-8) vs 10 (IQR 6-14); p = .003]. The inverse applied to the median IIEF score [5 (IQR 3-12) vs 2 (IQR 1-4); p = .02]. CONCLUSIONS: Functional outcomes at long-term follow-up after radical cystectomy and Studer ileal bladder substitute were at best modest in this series. Better outcomes during the second half of the study period might be explained by improved patient selection and a refined surgical technique, but possibly also by longer follow-up of patients during the first half of the period resulting in a more pronounced time-dependent decline in functional outcomes.