Association of Mode of Delivery With Urinary Incontinence and Changes in Urinary Incontinence Over the First Year Postpartum.
ABSTRACT To examine the association between vaginal or cesarean delivery and urinary incontinence (UI) and identify the trend in the change in UI within the first 12 months postpartum.
This was a prospective longitudinal study of 330 of 749 women who completed a UI questionnaire and a personal characteristics questionnaire over five visits in a medical center.
The vaginal delivery group had a significant higher prevalence of any UI at 4-6 weeks and at 3, 6, and 12 months (29.1-40.2% vaginal compared with 14.2-25.5% cesarean); stress urinary incontinence (SUI) at 4-6 weeks and 3 and 12 months (15.9-25.4% vaginal compared with 6.4-15.6% cesarean); and moderate or severe UI at 3-5 days, 4-6 weeks, and 6 months (7.9-18.5% vaginal compared with 4.3-11.3% cesarean); and a significant higher score for interference in daily life at 3-5 days and 4-6 weeks (1.0, 0.7 vaginal compared with 0.7, 0.4 cesarean) compared with those in the cesarean delivery group. Prevalence increased for any UI, SUI, and slight UI (all P<.02) and daily life interference score decreased (P=.02) for women who had a vaginal delivery through 1 year postpartum.
Vaginal delivery was associated with higher UI prevalence that persisted for 1 year postpartum, but there was no association with interference in daily life after 6 weeks postpartum. Variation was observed in UI changes within the first year in the vaginal delivery and cesarean delivery groups. LEVEL OF EVIDENCE:: II.
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ABSTRACT: We estimated the incidence and remission of lower urinary tract symptoms during the 12 years following the first pregnancy and delivery. In a cohort study 242 primiparae were questioned about lower urinary tract symptoms 3 months, 5 years and 12 years after the first delivery. From 3 months to 5 years after first delivery the incidence of stress urinary incontinence, urge urinary incontinence, urgency, diurnal frequency and nocturia was 56 of 213 cases (26.3%), 33 of 219 (15.1%), 33 of 206 (16.0%), 49 of 219 (22.4%) and 6 of 225 (2.7%), respectively. Remission of stress urinary incontinence, urge urinary incontinence, urgency, diurnal frequency and nocturia during the same period occurred in 1 of 11 cases (9.1%), 2 of 5 (40%), 2 of 5 (40%), 4 of 7 (57.1%) and 1 of 1 (100%), respectively. From 5 to 12 years after the first delivery the incidence of stress urinary incontinence, urge urinary incontinence, urgency, diurnal frequency and nocturia was 40 of 158 cases (25.3%), 25 of 188 (13.3%), 24 of 175 (13.7%), 40 of 174 (23.0%) and 13 of 220 (5.9%), respectively. Remission of stress urinary incontinence, urge urinary incontinence, urgency, diurnal frequency and nocturia during the same period occurred in 14 of 66 cases (21.2%), 13 of 36 (36.1%), 22 of 36 (61.1%), 14 of 52 (26.9%) and 4 of 6 (66.7%), respectively. Of 62 women with pure stress urinary incontinence during the first pregnancy and puerperium 20 (32.2%) had pure stress urinary incontinence, 3 (4.8%) had pure urge urinary incontinence and 15 (24.2%) had mixed urinary incontinence 12 years later. Of 13 women with pure urge urinary incontinence during the first pregnancy and puerperium 3 (23.1%) had pure urge urinary incontinence, 2 (15.4%) had pure stress urinary incontinence and 3 (23.1%) had mixed urinary incontinence 12 years later. The overall prevalence of lower urinary tract symptoms 12 years after the first delivery increased significantly. The incidence and remission of lower urinary tract symptoms after the first pregnancy and delivery fluctuate and the types of urinary incontinence may interchange, while the overall prevalence of lower urinary tract symptoms increases in the long term.The Journal of urology 09/2008; 180(3):992-7. DOI:10.1016/j.juro.2008.05.027 · 3.75 Impact Factor
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ABSTRACT: Urinary incontinence is a common symptom in many diseases as well as in general population. To measure the impact of urinary incontinence (UI) on individual's quality of life the English short form International Consultation on Incontinence questionnaire (ICIQ-UI Short Form) has been developed, which consists of three scored and one self-diagnostic question. Our aim was to translate the ICIQ-UI Short Form into Slovene, re-validate it, and test the diagnostic value of the questionnaire in determining the type of UI. ICIQ-UI Short Form was translated into Slovene and re-validated. In the validation process we included urology and gynecology outpatient clinics attendants, elderly institutionalized patients, and a community sample. One group of patients underwent urodynamic testing and the results were compared to their responses to question six of the ICIQ-UI Short Form. Both sets of answers were compared using the Kappa (kappa) statistics. The Slovene version of the ICIQ-UI Short Form was found to be valid (excellent test-retest reliability, good internal consistency, good responsiveness to change, and reflected well underlying theories). The questionnaire correlated well with urodynamic findings. The perceived cause of leakage (Question 6) was a good indicator of objectively proven cause of incontinence (Kappa value 0.77). We found that the Slovene version of the ICIQ-UI Short Form is a valid and reliable questionnaire for assessment of UI. In addition to its ability to assess the impact of UI on individual's quality of life it also has a diagnostic value of the cause of incontinence.Neurourology and Urodynamics 04/2009; 28(6):501-5. DOI:10.1002/nau.20689 · 2.67 Impact Factor
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ABSTRACT: To compare the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) with the Incontinence Severity Index (ISI), and to propose intervals for four severity levels of ICIQ-UI SF. Cross-sectional, Internet-based study of 1,812 women responding to a general health questionnaire. Four severity levels for the ICIQ-UI SF scores were constructed by iteratively adjusting the ranges for these levels until maximum Kappa scores were obtained when cross-tabulated with the ISI in a random sample of half of the women with urinary incontinence. Using these intervals, weighted Kappa was calculated for the remaining women as a validation process. Three hundred forty-three women had urinary incontinence, and completed the ISI and the ICIQ-UI SF. A high correlation between the ISI and ICIQ-UI SF scores with versus without the QoL item was found (Spearman's rho = 0.62, P < 0.01 vs. rho = 0.71, P < 0.01, respectively). Maximum Kappa with quadratic weighting was obtained for the following scale for the ICIQ-UI SF: slight (1-5), moderate (6-12), severe (13-18) and very severe (19-21) (Kappa = 0.61), and without the QoL item: slight (1-3), moderate (4-5), severe (6-9) and very severe (10-11) (Kappa = 0.71) in the development sample. Correspondingly, for the validating sample, maximum Kappa with quadratic weighting was 0.61 and 0.74. A high correlation between the ICIQ-UI SF and the ISI was found. The ICIQ-UI SF may be divided into the following four severity categories: slight (1-5), moderate (6-12), severe (13-18) and very severe (19-21). Neurourol. Urodynam. 28:411-415, 2009. (c) 2009 Wiley-Liss, Inc.Neurourology and Urodynamics 02/2009; 28(5):411-5. DOI:10.1002/nau.20674 · 2.67 Impact Factor