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1.
Medicine (Baltimore) ; 98(37): e16876, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31517813

RESUMO

INTRODUCTION: Randomized trials evaluating interventions for stress urinary incontinence (SUI) have been using variable outcome measures, reporting a variety of outcomes. Alongside this variation across studies, outcome-reporting flaws contribute to a limited use of research to inform clinical practice. The development and use of core outcome sets (COSs) in future trials would ensure that outcomes important to different stakeholders and primarily women with SUI are reported more consistently and comprehensively. METHODS: An international steering group including healthcare professionals, researchers, and women with urinary incontinence will guide the development of this COS. Potential outcomes will be identified through comprehensive literature reviews. These outcomes will be entered into an international, multiperspective online Delphi survey. All key stakeholders, including healthcare professionals, researchers, and women with urinary incontinence, will be invited to participate. The modified Delphi method encourages stakeholder group convergence toward collective agreement, also referred as consensus, core outcomes. DISCUSSION: Dissemination and implementation of the resulting COS within an international context will be promoted and reviewed. Embedding the COS for SUI within future clinical trials, systematic reviews and clinical practice guidelines could make a significant contribution to advancing the value of research in informing clinical practice, enhancing patient care and improving outcomes. The infrastructure created by developing a COS for SUI could be leveraged in other settings, for example, selecting research priorities and clinical practice guideline development.


Assuntos
Conferências de Consenso como Assunto , Incontinência Urinária por Estresse/diagnóstico , Incontinência Urinária por Estresse/terapia , Técnica Delfos , Feminino , Pessoal de Saúde , Humanos , Projetos de Pesquisa , Revisões Sistemáticas como Assunto , Resultado do Tratamento
2.
Urology ; 133: 91-95, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31415780

RESUMO

OBJECTIVE: To estimate the minimum clinically important difference (MCID) of the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) and the International Consultation on Incontinence Questionnaire-Lower Urinary Tract Symptoms Quality of Life (ICIQ-LUTSqol) using both anchor-based and distribution-based methods for women with stress urinary incontinence undergoing nonsurgical treatment. MATERIALS AND METHODS: Data from a randomized clinical trial evaluating efficacy of a nonsurgical intervention in women with stress urinary incontinence were used for analyses. The overall score of ICIQ-UI SF ranges from 0 to 21, with greater values indicating increased severity. The ICIQ-LUTSqol ranges from 19 to 76, with greater values indicating increased impact on quality of life. Instruments used in the anchor-based method were the Patient Global Impression of Improvement, patient satisfaction, 1-hour pad test and the incontinence episode frequency. The distribution-based method used an effect size of 0.5 standard deviation. Triangulation of findings was used to converge on a single value of MCID. RESULTS: At 12-month post-treatment, 106 (88.3%) participants completed the follow-up and were included in the analysis. Anchor-based MCIDs of the ICIQ-UI SF were between 3.4 and 4.4, while the distribution-based MCID was 1.7. Anchor-based MCIDs of the ICIQ-LUTSqol were between 4.8 and 6.9, while the distribution-based MCID was 5.2. Triangulation of findings showed that MCIDs of 4 for ICIQ-UI SF and 6 for ICIQ-LUTSqol were the most appropriate. CONCLUSION: For women undergoing nonsurgical treatments for incontinence, reductions of 4 and 6 points in ICIQ-UI SF and ICIQ-LUTSqol, respectively are perceived as clinically meaningful.


Assuntos
Autoavaliação Diagnóstica , Qualidade de Vida , Autorrelato , Incontinência Urinária por Estresse/diagnóstico , Incontinência Urinária por Estresse/terapia , Feminino , Humanos , Sintomas do Trato Urinário Inferior/diagnóstico , Pessoa de Meia-Idade , Índice de Gravidade de Doença
3.
Ceska Gynekol ; 84(2): 115-120, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31238681

RESUMO

OBJECTIVE: Is it possible to estimate urethral mobility based on MUCP measurements? DESIGN: Retrospective study. SETTING: Department of Gynecology and Obstetrics, 1st Medical Faculty, Charles University, General Teaching Hospital, Prague. METHODS: This retrospective study included 567 patients from three prospective studies within years 2002 to 2009. Ultrasound examination was performed in 560 of them and maximal urethral closure pressure (MUCP) values were measured in 507 women. The MUCP was defined as the difference between maximum urethral pressure and bladder pressure. An ultrasound examination was performed using the transperineal approach in accordance with the recommendations of the German Urogynecology Working Group and ICS, IUGA terminology. The mobility was expressed as a distance between the position at rest and at the maximal Valsalva manoeuvre. Data were summarized as mean and median, with SD and quantile range for measures of variability. Either a matched pairs t-test or Wilcoxon test was used for statistical evaluation. RESULTS: Mean MUCP was 47.4 cm H2O (SD 22.2, first quantile 32, third quantile 62). Mean urethral descent was 20.6 mm (SD 8.2, first quantile 14.9, third quantile 25.6 mm). Using regression analysis there was an increase in urethral descent; this difference is statistically significant. For a MUCP increase of 10 cm H2O we could estimate an increase in urethral descent of 1.1 mm. CONCLUSION: We established a statistically significant relationship between urethral descent and MUCP. Unfortunately those differences are not clinically relevant, especially for MUCP over 20 cm H2O. For MUCP below 20 cm H2O low urethral descent is more likely. Clinical use of MUCP as predictor of urethral descent is limited due to the high variability involved.


Assuntos
Uretra/fisiopatologia , Incontinência Urinária por Estresse/cirurgia , Urodinâmica/fisiologia , Feminino , Humanos , Masculino , Gravidez , Estudos Prospectivos , Estudos Retrospectivos , Resultado do Tratamento , Bexiga Urinária/fisiopatologia , Incontinência Urinária por Estresse/diagnóstico , Procedimentos Cirúrgicos Urológicos/efeitos adversos
4.
Urologe A ; 58(6): 640-650, 2019 Jun.
Artigo em Alemão | MEDLINE | ID: mdl-31089755

RESUMO

The differentiated surgical treatment of male urinary incontinence is a very interesting and sometimes also emotional topic, in which evidence is increasingly maturing. Nowadays, the most common surgical procedures are fixed sling and adjustable incontinence systems as well as the artificial urinary sphincter. The evidence for the procedures varies and there is currently a lack of prospective, comparative studies. The challenging question is: Which operation is the best for which patient? The following article is intended to give an overview of the surgical options and a constructive attempt to differentiate the indication.


Assuntos
Próteses e Implantes , Slings Suburetrais , Incontinência Urinária por Estresse/cirurgia , Esfíncter Urinário Artificial , Procedimentos Cirúrgicos Urológicos/métodos , Humanos , Intenção , Masculino , Complicações Pós-Operatórias/cirurgia , Prostatectomia , Resultado do Tratamento , Incontinência Urinária por Estresse/diagnóstico , Incontinência Urinária por Estresse/etiologia , Procedimentos Cirúrgicos Urológicos Masculinos
5.
Eur J Obstet Gynecol Reprod Biol ; 237: 13-17, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30978581

RESUMO

OBJECTIVE: The aim of this study was to perform a score predictive of ALPP <60 cm H2O from clinical factors in women with stress urinary incontinence (SUI). STUDY DESIGN: We performed a descriptive and observational study of women referred for a urodynamic study for stress urinary incontinence. Patients were divided into three groups: ALPP: >90 cm H2O, between 60 and 90 cm H2O and <60 cm H2O. A logistic regression study was performed in order to complete clinical predictors of ALPP < 60 cm H2O. Variables that were significant in the multivariate analysis were included in the score. RESULTS: We studied 158 patients: 65 presented ALPP > 90 cm H2O, 64 between 60-90 cm H2O and 29 <60 cm H2O. In the multivariate analysis, were presented as independent predictors of ALPP < 60 cm H2O, the presence of a fixed urethra (p 0.01), empty bladder test positive (p 0.02) and presence of symptoms grade III in the classification of Stamey (p 0.03). The accuracy of the test was: score 0, 42%; score 1, 58%; score 2, 81%. Receiver Operating Characteristic (ROC) analysis for the overall cutoff points revealed an area under the curve of 0,75. CONCLUSIONS: Presence of a fixed urethra, positive empty bladder test and patients with a high degree of SUI symptoms according to the Stamey score are independent clinical predictors of intrinsic sphincter deficiency. This score could represent a useful clinical tool to predict the presence of ALPP <60 cm H2O based on clinical parameters.


Assuntos
Técnicas de Diagnóstico Urológico , Incontinência Urinária por Estresse/diagnóstico , Urodinâmica/fisiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Pessoa de Meia-Idade , Uretra/fisiopatologia , Bexiga Urinária/fisiopatologia , Incontinência Urinária por Estresse/fisiopatologia
6.
Curr Urol Rep ; 20(5): 23, 2019 Mar 30.
Artigo em Inglês | MEDLINE | ID: mdl-30929095

RESUMO

PURPOSE OF REVIEW: The purpose of this paper is to review (1) the epidemiology and pathophysiology of pelvic organ prolapse (POP) and occult stress urinary incontinence (SUI), (2) examine the data on combined operative management of POP and occult SUI, (3) discuss the approaches to clinical decision making, and (4) present future therapies. RECENT FINDINGS: Prospective data on many approaches to concomitant treatment of prolapse and occult stress urinary incontinence, such as minimally invasive sacrocolpopexy and midurethral sling, or older approaches that have regained favor among patients and clinicians wishing to avoid synthetic mesh, such as native tissue prolapse repair and pubovaginal sling, are limited. Safe durable treatments with absorbable graft materials that promote a beneficial host response are intriguing but may be far from clinical implementation. Stem cell therapy for the treatment of stress urinary incontinence has demonstrated benefit in phase I/II trials but has not been studied in the setting of concomitant treatment of occult SUI with POP surgery and remains in the preclinical phase for the treatment of POP. A personalized approach to concomitant SUI surgery that incorporates individual risk assessment as well as informed patient preferences likely optimizes the risk/benefit ratio and patient satisfaction. Novel therapies, including graft materials and cellular therapies that stimulate a regenerative response, may improve or maintain continence outcomes while mitigating risk and alter the approach to both POP and SUI surgery.


Assuntos
Prolapso de Órgão Pélvico/cirurgia , Incontinência Urinária por Estresse/cirurgia , Feminino , Humanos , Pessoa de Meia-Idade , Prolapso de Órgão Pélvico/complicações , Prolapso de Órgão Pélvico/epidemiologia , Prolapso de Órgão Pélvico/fisiopatologia , Estudos Prospectivos , Medição de Risco , Slings Suburetrais , Incontinência Urinária por Estresse/diagnóstico , Incontinência Urinária por Estresse/etiologia
7.
Rom J Intern Med ; 57(3): 220-232, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-30990789

RESUMO

A significant workforce shortage of urologists available to serve the US population has been projected to occur over the next decade. Accordingly, much of the management of urologic patients will need to be assumed by other specialties and practitioners. Since primary care physicians are often first evaluate common urologic complaints, it makes sense that these physicians are in an excellent position to intervene in the management of these patients when appropriate. One of the most common complaints in urology is voiding dysfunction. The incidence of voiding dysfunction increases with age, with conservative estimates showing that over 50% of elderly patients suffer. Despite this high prevalence and its negative impact on quality of life, however, few seek or receive treatment, as many do not readily disclose these impactful yet personal symptoms. We sought to summarize the typical presentation, evaluation, assessment and therapeutic options for both male and female patients presenting with voiding dysfunction.


Assuntos
Prostatismo/terapia , Bexiga Urinária Hiperativa/terapia , Transtornos Urinários/diagnóstico , Transtornos Urinários/terapia , Cistite Intersticial/diagnóstico , Cistite Intersticial/etiologia , Cistite Intersticial/terapia , Feminino , Humanos , Masculino , Prostatismo/diagnóstico , Prostatismo/etiologia , Bexiga Urinária Hiperativa/diagnóstico , Bexiga Urinária Hiperativa/etiologia , Bexiga Inativa/diagnóstico , Bexiga Inativa/etiologia , Bexiga Inativa/terapia , Incontinência Urinária por Estresse/diagnóstico , Incontinência Urinária por Estresse/etiologia , Incontinência Urinária por Estresse/terapia , Transtornos Urinários/etiologia
8.
Trials ; 20(1): 237, 2019 Apr 25.
Artigo em Inglês | MEDLINE | ID: mdl-31023381

RESUMO

BACKGROUND: Stress urinary incontinence (SUI) is highly prevalent during pregnancy and after delivery. It is often associated with a failing pelvic floor, sphincteric and/or supportive system. Pelvic-floor-muscle training (PFMT) peri-partum has been proven effective for up to 1 year post-partum; however, its long-term effects are unknown. Group PFMT, given by a physiotherapist, has been proven to be as equally effective as individual therapy. Motherfit is a group-PFMT therapy with an emphasis on pelvic floor exercises, adherence and general fitness. Care-as-usual (CAU), if guideline driven, should, as first treatment option, consist of PFMT. Cost-effective strategies are of relevance, given the rise of health care costs. Motherfit group therapy has the potential to be cost-effective in women with urinary incontinence. Therefore, the objectives of the two current studies are: (1) to investigate whether intensive, supervised, pre-partum (MOTHERFIT1) or post-partum (MOTHERFIT2) pelvic-floor-muscle group therapy reduces 18-month post-partum severity of SUI compared to CAU and (2) whether MOTHERFIT1 OR MOTHERFIT 2 is more (cost-)effective compared to CAU. METHODS: Two multi-centred, randomised controlled trials (MOTHERFIT1, n = 150, MOTHERFIT2, n = 90) will be performed. Participants will be recruited by their midwife or gynaecologist during their routine check. Participants with SUI will receive either motherfit group therapy or CAU. Motherfit group therapy consists of eight group sessions of 60 min each, instructed and supervised by a registered pelvic physiotherapist. Motherfit group therapy includes instructions on pelvic floor anatomy and how to contract, relax and train the pelvic-floor muscles correctly and is combined with general physical exercises. Adherence during and after motherfit will be stimulated by reinforcement techniques and a mobile app. The primary outcome measure is the absence of self-reported SUI based on the severity sum score of the International Consultation on Incontinence Questionnaire Short Form (ICIQ-UI-SF) at 18 months post-partum. Secondary outcomes evaluate quality of life, subjective improvement and health care costs. DISCUSSION: The motherfit studies are, to our knowledge, the first studies that evaluate both long-term results and health care costs compared to CAU in pregnant and post-partum women with SUI. If motherfit is shown to be (cost-)effective, implementation in peri-partum care should be considered. TRIAL REGISTRATION: Netherlands Trial Register, ID: NL5816 . Registered on 18 July 2016.


Assuntos
Terapia por Exercício/métodos , Grupo Associado , Diafragma da Pelve/fisiopatologia , Assistência Perinatal/métodos , Complicações na Gravidez/prevenção & controle , Incontinência Urinária por Estresse/prevenção & controle , Feminino , Humanos , Estudos Multicêntricos como Assunto , Países Baixos , Período Pós-Parto , Gravidez , Complicações na Gravidez/diagnóstico , Complicações na Gravidez/etiologia , Complicações na Gravidez/fisiopatologia , Fatores de Proteção , Psicoterapia de Grupo , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Incontinência Urinária por Estresse/diagnóstico , Incontinência Urinária por Estresse/etiologia , Incontinência Urinária por Estresse/fisiopatologia
10.
Obstet Gynecol ; 133(4): 683-690, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30870279

RESUMO

OBJECTIVE: To validate a previously developed prediction model for de novo stress urinary incontinence (SUI) after undergoing vaginal surgery for pelvic organ prolapse (POP). METHODS: Model performance was determined using a cohort of women who participated in two, 14-center randomized trials in the Netherlands that evaluated whether postoperative SUI 1 year after surgery was reduced with or without concomitant midurethral sling at the time of surgery for symptomatic women who had at least stage 2 POP. Age, number of previous vaginal births, urine leakage associated with urgency, history of diabetes, body mass index, preoperative stress test result, and placement of a midurethral sling were used to calculate the predicted probability of an individual developing de novo SUI. Predicted probabilities were compared with outcomes and quantitated using the concordance index and calibration curves. Model accuracy was compared with and without the preoperative stress test, and net reclassification improvement was measured using probability cutoffs of 0.2, 0.3, and 0.4. RESULTS: Of 239 participants who did not report preoperative SUI and underwent surgery, 152 were eligible for analysis with complete baseline and outcome data. Model discrimination was acceptable and consistent with performance in the original development cohort when the preoperative stress test result was included (concordance index 0.63; 95% CI 0.52-0.74) and had lower discrimination than when the stress test variable was not included (concordance index 0.57; 95% CI 0.46-0.67, P=.048). The model that included the stress test variable was most accurate when predicted probabilities of de novo SUI were between 0 and 50%, and it correctly reclassified upward 5.9% (95% CI -14.8 to 26.8) of participants with de novo SUI and correctly reclassified downward 16.9% (95% CI 6.6-27.7) of participants without de novo SUI. CONCLUSION: On external validation, the model was predictive of de novo SUI after vaginal prolapse surgery and may facilitate decision making regarding concomitant sling placement. CLINICAL TRIAL REGISTRATION: Nederlands Trial Register, NTRR 1197 en 1070.


Assuntos
Prolapso de Órgão Pélvico/cirurgia , Incontinência Urinária por Estresse/diagnóstico , Procedimentos Cirúrgicos Urogenitais/efeitos adversos , Procedimentos Cirúrgicos Urogenitais/métodos , Idoso , Feminino , Humanos , Pessoa de Meia-Idade , Modelos Teóricos , Países Baixos , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Probabilidade , Slings Suburetrais , Incontinência Urinária por Estresse/epidemiologia , Incontinência Urinária por Estresse/etiologia , Urodinâmica
11.
Geriatr Gerontol Int ; 19(4): 299-304, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30811813

RESUMO

AIM: The aim of the present study was to investigate the effect of female pelvic floor dysfunction on sexual function and quality of life among different age groups. METHODS: An observational study was carried out on 648 patients with pelvic organ prolapse (POP) or/and stress urinary incontinence. We assessed female sexual function and quality of life through the Prolapse/Urinary Incontinence Sexual Questionnaire Short Form and Incontinence Quality of Life Scale before surgeries, respectively. Patients were assigned into different age groups. RESULTS: The mean age of all patients was 62.04 ± 9.39 years. A total of 436 patients had POP, 120 patients had stress urinary incontinence and the remaining patients had both. Although sexual frequency decreased with increasing age, 517 patients still remained sexually active. A total of 10.83% of the patients aged ≥70 years were still sexually active, and 8.51% of them had sex less than one time per month. The Prolapse/Urinary Incontinence Sexual Questionnaire Short Form score and sexual frequency decreased with increasing age. However, the Incontinence Quality of Life Scale score increased with increasing age. Patients with only POP and aged ≥70 years showed a higher Incontinence Quality of Life Scale score (P < 0.001). CONCLUSIONS: The present study showed that POP and stress urinary incontinence are common among older Chinese women, and re associated with decreased sexual satisfaction and quality of life in China. It suggests that the existing sexual requirement of these patients should also be reconsidered before surgical assessment. Doctors should take sexual satisfaction into consideration when choosing a personalized type of surgery to improve the patients' quality of life physiologically and psychologically. Geriatr Gerontol Int 2019; 19: 299-304.


Assuntos
Diafragma da Pelve/fisiopatologia , Prolapso de Órgão Pélvico , Qualidade de Vida , Disfunções Sexuais Fisiológicas , Incontinência Urinária por Estresse , Idoso , China/epidemiologia , Feminino , Humanos , Pessoa de Meia-Idade , Orgasmo , Prolapso de Órgão Pélvico/complicações , Prolapso de Órgão Pélvico/diagnóstico , Prolapso de Órgão Pélvico/epidemiologia , Pesquisa Qualitativa , Disfunções Sexuais Fisiológicas/epidemiologia , Disfunções Sexuais Fisiológicas/etiologia , Disfunções Sexuais Fisiológicas/fisiopatologia , Disfunções Sexuais Fisiológicas/psicologia , Incontinência Urinária por Estresse/complicações , Incontinência Urinária por Estresse/diagnóstico , Incontinência Urinária por Estresse/epidemiologia
12.
Am J Obstet Gynecol ; 220(1): 87.e1-87.e13, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30595143

RESUMO

BACKGROUND: Because of the limitations of existing clinical treatments for urinary incontinence, many women with incontinence are interested in complementary strategies for managing their symptoms. Yoga has been recommended as a behavioral self-management strategy for incontinence, but evidence of its feasibility, tolerability, and efficacy is lacking. OBJECTIVE: To evaluate the feasibility and tolerability of a group-based therapeutic yoga program for ambulatory middle-aged and older women with incontinence, and to examine preliminary changes in incontinence frequency as the primary efficacy outcome after 3 months. MATERIALS AND METHODS: Ambulatory women aged 50 years or older who reported at least daily stress-, urgency-, or mixed-type incontinence, were not already engaged in yoga, and were willing to temporarily forgo clinical incontinence treatments were recruited into a randomized trial in the San Francisco Bay area. Women were randomly assigned to take part in a program of twice-weekly group classes and once-weekly home practice focused on Iyengar-based yoga techniques selected by an expert yoga panel (yoga group), or a nonspecific muscle stretching and strengthening program designed to provide a rigorous time-and-attention control (control group) for 3 months. All participants also received written, evidence-based information about behavioral incontinence self-management techniques (pelvic floor exercises, bladder training) consistent with usual first-line care. Incontinence frequency and type were assessed by validated voiding diaries. Analysis of covariance models examined within- and between-group changes in incontinence frequency as the primary efficacy outcome over 3 months. RESULTS: Of the 56 women randomized (28 to yoga, 28 to control), the mean age was 65.4 (±8.1) years (range, 55-83 years), the mean baseline incontinence frequency was 3.5 (±2.0) episodes/d, and 37 women (66%) had urgency-predominant incontinence. A total of 50 women completed their assigned 3-month intervention program (89%), including 27 in the yoga and 23 in the control group (P = .19). Of those, 24 (89%) in the yoga and 20 (87%) in the control group attended at least 80% of group classes. Over 3 months, total incontinence frequency decreased by an average of 76% from baseline in the yoga and 56% in the control group (P = .07 for between-group difference). Stress incontinence frequency also decreased by an average of 61% in the yoga group and 35% in controls (P = .045 for between-group difference), but changes in urgency incontinence frequency did not differ significantly between groups. A total of 48 nonserious adverse events were reported, including 23 in the yoga and 25 in the control group, but none were directly attributable to yoga or control program practice. CONCLUSION: Findings demonstrate the feasibility of recruiting and retaining incontinent women across the aging spectrum into a therapeutic yoga program, and provide preliminary evidence of reduction in total and stress-type incontinence frequency after 3 months of yoga practice. When taught with attention to women's clinical needs, yoga may offer a potential community-based behavioral self-management strategy for incontinence to enhance clinical treatment, although future research should assess whether yoga offers unique benefits for incontinence above and beyond other physical activity-based interventions.


Assuntos
Qualidade de Vida , Incontinência Urinária/diagnóstico , Incontinência Urinária/reabilitação , Ioga , Centros Médicos Acadêmicos , Fatores Etários , Idoso , Terapia por Exercício/métodos , Estudos de Viabilidade , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Cooperação do Paciente/estatística & dados numéricos , Seleção de Pacientes , Diafragma da Pelve , Avaliação de Programas e Projetos de Saúde , Valores de Referência , Resultado do Tratamento , Incontinência Urinária/psicologia , Incontinência Urinária por Estresse/diagnóstico , Incontinência Urinária por Estresse/reabilitação
13.
Int Urogynecol J ; 30(1): 139-147, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30460380

RESUMO

INTRODUCTION AND HYPOTHESIS: The objective of the present study was to adapt the CONTILIFE, a quality-of-life questionnaire, into Turkish and to reveal its psychometric properties in women suffering from stress urinary incontinence (SUI). METHODS: Ninety-eight patients with a symptom of SUI participated in the study and filled out the Turkish CONTILIFE. Cronbach's alpha (α) and intraclass correlation coefficients (ICCs) were evaluated for the internal consistency and test-retest reliability, respectively. Exploratory factor analysis was performed to determine the underlying structure. Criterion validity was analyzed using the correlation coefficients between the total and subscale scores of the CONTILIFE and King's Health Questionnaire (KHQ), the Incontinence Impact Questionnaire-7 (IIQ-7), and the Urinary Distress Inventory-6 (UDI-6). RESULTS: Internal consistency was found to be strong to very strong (Cronbach's α: 0.90-0.96). Test-retest reliability was very strong (ICCs = 0.91-0.98, p < 0.001). Exploratory factor analysis revealed five significant factors, explained by 74% of the total variance. Total scores on the CONTILIFE were significantly correlated with the KHQ subscales (r = -0.43 - -0.81), IIQ-7 (r = -0.89), UDI-6 (r = -0.66), and ISI (r = -0.66); (p < 0.01). CONCLUSION: The Turkish CONTILIFE is a valid and reliable tool to determine the influence of SUI on health-related quality of life in Turkish women.


Assuntos
Inquéritos e Questionários , Incontinência Urinária por Estresse/psicologia , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Psicometria , Qualidade de Vida , Turquia , Incontinência Urinária por Estresse/diagnóstico
14.
Int Urogynecol J ; 30(5): 823-829, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-29845305

RESUMO

INTRODUCTION AND HYPOTHESIS: Patient history is often insufficient to identify type of urinary incontinence (UI). Multichannel urodynamic testing (UDS) is often used to clarify the diagnosis. Dynamic cystoscopy (DC) is a novel approach for testing bladder function. The primary objective of this study was to investigate the diagnostic agreement of UDS and DC in evaluating women with mixed urinary incontinence (MUI). METHODS: Women presenting with MUI were approached for enrollment if UDS and DC were planned for further investigation. Investigators were blinded to history and comparative test results. McNemar's test and kappa coefficient were calculated to assess agreement between UDS and DC. Receiver operating characteristic (ROC) analysis was used to explore the best possible filling sensation cutoffs for DC that would best predict the filling sensation cutoffs from UDS. RESULTS: Sixty participants were included, of whom, four were excluded for protocol violation. For the primary outcome measure of agreement, UDS and DC were concordant in 44/56 of stress urinary incontinence (SUI) cases (79%) with a κ= 0.54 and in 43/56 of urinary urge incontinence (UUI) cases (77%) with a κ= 0.54, indicating moderate, nearly substantial agreement. ROC analysis identified the best prediction of DC first urge to void as 148 cm3, strong urge 215 cm3, and maximum capacity at 246 cm3. These parameters were used to compare UDS UUI to DC UUI and resulted in a κ = 0.61 (p = 0.37), indicating substantial agreement. CONCLUSIONS: When compared with UDS, DC shows moderate agreement for detection of SUI and substantial agreement for detection of UUI.


Assuntos
Cistoscopia/métodos , Incontinência Urinária por Estresse/diagnóstico , Incontinência Urinária de Urgência/diagnóstico , Urodinâmica/fisiologia , Adulto , Idoso , Feminino , Humanos , Pessoa de Meia-Idade , Estudos Prospectivos , Sensibilidade e Especificidade , Inquéritos e Questionários
15.
World J Urol ; 37(1): 189-193, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29872900

RESUMO

PURPOSE: To investigate Occult Stress Urinary Incontinence (OSUI) using physical exam (PE) and urodynamics (UDS) in women with advanced pelvic organ prolapse (POP), and compare the two methods. METHODS: This study comprised 105 women with POP stage-III and -IV, according to POP quantification (POP-Q) system, evaluated prospectively between January and December 2015. A standard history, an incontinence questionnaire and PE were completed before the investigation of the OSUI that was performed in the supine and standing positions, reducing the prolapse using gauze and Cheron dressing forceps. The stress test was performed with and without the prolapse reduction. RESULTS: The mean patient age was 65.7 years, mean parity 5.1 and mean body mass index 27.4. From a total of 105 patients, 70 (66.7%) presented with POP-Q stage III and 35 (33.3%) stage IV. Sixty-three (60%) women were identified as having OSUI, 27 (25.7%) as continent, and 15 (14.3%) having stress urinary incontinence. From the 63 OSUI subjects, 48 (76.2%) were identified in both evaluations, eight were identified only during PE, and seven only during UDS. The sensitivity to detect OSUI during PE and UDS was 88.9 and 87.3%, respectively (P = .783). The kappa value to measure the agreement between both tests was .648 (95% CI .441-.854). CONCLUSION: UDS and PE are equivalent and concordant to demonstrate OSUI, thus it is not necessary to perform UDS to exclusively identify OSUI. UDS utility in OSUI patients, to evaluate urethral and detrusor function, deserves further investigation.


Assuntos
Prolapso de Órgão Pélvico/complicações , Exame Físico , Incontinência Urinária por Estresse/diagnóstico , Urodinâmica , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Pessoa de Meia-Idade , Estudos Prospectivos , Sensibilidade e Especificidade , Inquéritos e Questionários , Incontinência Urinária por Estresse/etiologia
17.
Arch Esp Urol ; 71(9): 752-756, 2018 Nov.
Artigo em Espanhol | MEDLINE | ID: mdl-30403377

RESUMO

OBJECTIVES: To evaluate if there is a correlation between the abdominal leak pressure point (ALPP) of the urodynamic study and several tools to evaluate severity and quality of life associated to stress urine incontinence (SUI). METHODS: Prospective correlation study of women referred to urodynamic study for stress urinary incontinence in Centro Urológico Profesor Bengió between September 2014 and October 2015. Anamnesis, physical examination (where the SUI was demonstrated), ICIQSF urine incontinence questionnaire and incontinence impact questionnaire (IIQ-7) were performed to every patient. Uroflowmetry and complete urodynamic study were performed in all cases. Intrinsic sphincter deficiency (ISD) was defined as ALPP value ≤ 60 cm H2O. The relation between abdominal leak pressure point (ALPP) and incontinence severity measurements and quality of life (daily protectors, Sandvik score, ISIQ-SF score and short IIQ7 score) was evaluated with the Spearman coefficient correlation. RESULTS: 105 females were studied. Mean ALPP was 84 H2O cm (30-170). 21 and 84 patients had ALPP values lower and higher than 60 H2O cm respectively. There were no differences between the groups when general and demographic characteristics were evaluated. No correlation between ALPP and incontinence severity measurements was demonstrated: daily protectors (ρ 0.10; p NS), Sandvik severity score (ρ 0.05; p NS), ISIQ-SF score (ρ 0.0004; p NS) and IIQ7 Score (ρ 0.06; p NS). When patients with IED (ALPP ≤ 60 cm H2O) and those without IED DEI (ALPP > 60 cm H2O) were analyzed, there was no statistically significant difference between the groups in the comparison according to severity and quality of life questionnaires. CONCLUSIONS: In this series, there is not a significant correlation between abdominal leak pressure point and severity and quality of life measurements in patients with stress urinary incontinence.


Assuntos
Qualidade de Vida , Incontinência Urinária por Estresse/diagnóstico , Incontinência Urinária por Estresse/fisiopatologia , Urodinâmica , Abdome , Adulto , Idoso , Feminino , Humanos , Pessoa de Meia-Idade , Pressão , Estudos Prospectivos , Índice de Gravidade de Doença
18.
Arch. esp. urol. (Ed. impr.) ; 71(9): 752-756, nov. 2018. tab
Artigo em Espanhol | IBECS | ID: ibc-178753

RESUMO

Objetivos: Evaluar si existe correlación entre el punto de presión de pérdida abdominal (ALPP) del estudio urodinámico y diversas herramientas para evaluar severidad y calidad de vida asociada a incontinencia de orina de esfuerzo (IOE). Métodos: Estudio prospectivo y de correlación en mujeres derivadas para estudio urodinámico por incontinencia de orina de esfuerzo en el Centro Urológico Profesor Bengió entre septiembre de 2014 y octubre de 2015. A todas las pacientes se les realizó interrogatorio, examen físico (donde se evidenció IOE), cuestionario de incontinencia urinaria ICIQ-SF y cuestionario de impacto de incontinencia (IIQ-7). En todos los casos se les realizó uroflujometría y estudio urodinámico completo. Se definió deficiencia esfinteriana intrínseca (DEI) cuando el valor de ALPP fue ≤ a 60 cm H2O. La relación entre punto de presión de perdida abdominal (ALPP) y las mediciones de severidad de incontinencia y calidad de vida (protectores diarios, score de Sandvik, score ISIQ-SF y score IIQ7 corto) fue evaluada con el coeficiente de correlación de Spearman. Resultados: Se estudiaron 105 mujeres. La media de ALPP fue 84 cm H2O (30-170). Los pacientes con ALPP menor y mayor a 60 cm H2O fueron 21 y 84 respectivamente. No existen diferencias entre los grupos al evaluar características generales y demográficas. No evidenciamos alguna correlación entre ALPP y las mediciones de severidad de incontinencia: protectores diarios (ρ 0,10; p NS), score de severidad de Sandvik (ρ 0,05; p NS), score ISIQ-SF (ρ 0,0004; p NS) y Score IIQ7 (ρ 0,06; p NS). Al analizar los pacientes con DEI (ALPP ≤ 60 cm H2O) de aquellos sin DEI (ALPP > 60 cm H2O) no evidenciamos diferencias estadísticamente significativas entre los grupos al ser comparados según cuestionarios de severidad y calidad de vida. Conclusiones: En nuestra serie, no existe una correlación significativa entre el punto de presión de pérdida abdominal y las mediciones de severidad y calidad de vida de pacientes con incontinencia de orina de esfuerzo


Objectives: To evaluate if there is a correlation between the abdominal leak pressure point (ALPP) of the urodynamic study and several tools to evaluate severity and quality of life associated to stress urine incontinence (SUI). Methods: Prospective correlation study of women referred to urodynamic study for stress urinary incontinence in Centro Urológico Profesor Bengió between September 2014 and October 2015. Anamnesis, physical examination (where the SUI was demonstrated), ICIQSF urine incontinence questionnaire and incontinence impact questionnaire (IIQ-7) were performed to every patient. Uroflowmetry and complete urodynamic study were performed in all cases. Intrinsic sphincter deficiency (ISD) was defined as ALPP value ≤60 cm H2O. The relation between abdominal leak pressure point (ALPP) and incontinence severity measurements and quality of life (daily protectors, Sandvik score, ISIQ-SF score and short IIQ7 score) was evaluated with the Spearman coefficient correlation. Results: 105 females were studied. Mean ALPP was 84 H2O cm (30-170). 21 and 84 patients had ALPP values lower and higher than 60 H2O cm respectively. There were no differences between the groups when general and demographic characteristics were evaluated. No correlation between ALPP and incontinence severity measurements was demonstrated: daily protectors (>0.10; p NS), Sandvik severity score (>0.05; p NS), ISIQ-SF score (>0.0004; p NS) and IIQ7 Score (>0.06; p NS). When patients with IED (ALPP >60 cm H2O) and those without IED DEI (ALPP > 60 cm H2O) were analyzed, there was no statistically significant difference between the groups in the comparison according to severity and quality of life questionnaires. Conclusions: In this series, there is not a significant correlation between abdominal leak pressure point and severity and quality of life measurements in patients with stress urinary incontinence


Assuntos
Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Qualidade de Vida , Incontinência Urinária por Estresse/diagnóstico , Incontinência Urinária por Estresse/fisiopatologia , Urodinâmica , Abdome , Estudos Prospectivos , Pressão , Índice de Gravidade de Doença
19.
Clin Interv Aging ; 13: 1893-1898, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30323575

RESUMO

Objective: The aim of the study was to assess the myostatin concentration and an improvement in the severity of urinary incontinence (UI) after pelvic floor muscle training (PFMT) in a group of elderly women with stress UI. Methods: A total of 74 participants were included in the analysis: 40 participants in the experimental group (EG) and 34 participants in the control group (CG). The EG underwent PFMT, whereas no therapeutic intervention was applied to the CG. Myostatin concentration and UI severity (Revised Urinary Incontinence Scale [RUIS]) were assessed in all women before and after the treatment. Results: By comparing the results before and after the treatment, we have been able to demonstrate a statistically significant decrease in myostatin concentration (P<0.0001) and an improvement in the severity of UI (RUIS) (P<0.0001) in the EG. No statistically significant differences in all measured variables were reported before and after the treatment in the CG. A lower myostatin concentration (P=0.0084) and an improvement in the severity of UI (RUIS) (P=0.0008) were observed after the treatment in the EG compared to that in the CG. Conclusion: Effective PFMT causes downregulation of myostatin concentration and an improvement in the severity of UI in elderly women with stress UI. Further trials on a larger EG and an assessment of long-term treatment outcomes are required.


Assuntos
Terapia por Exercício/métodos , Miostatina/sangue , Diafragma da Pelve/fisiopatologia , Incontinência Urinária por Estresse , Idoso , Feminino , Humanos , Pessoa de Meia-Idade , Projetos Piloto , Índice de Gravidade de Doença , Resultado do Tratamento , Incontinência Urinária por Estresse/sangue , Incontinência Urinária por Estresse/diagnóstico , Incontinência Urinária por Estresse/fisiopatologia , Incontinência Urinária por Estresse/terapia
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