ArticleLiterature Review

Economic Burden of Urgency Urinary Incontinence in the United States: A Systematic Review

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Abstract

The International Continence Society (ICS) identifies several urinary incontinence (UI) subtypes: urgency urinary incontinence (UUI), stress UI (SUI), and mixed UI (MUI). UUI is a common symptom of overactive bladder (OAB) syndrome. Based on the current ICS definition of OAB, all patients with UUI have OAB, whereas not all patients with OAB have UUI. Because UUI is a chronic condition that is expected to increase in prevalence as the population of elderly individuals grows, it is important to understand its economic burden on society and patients and its cost components. To summarize the published English language medical literature on estimates of the economic burden of UUI in the United States from a societal and patient perspective, including direct costs (diagnosis, treatment, routine care [including incontinence pads], and UUI-associated comorbidities/complications); indirect costs (lost wages by patients and caregivers and lost work productivity due to absenteeism and presenteeism); and intangible costs (pain, suffering, and decreased health-related quality of life). A PubMed search of the literature for articles on the economic burden of UUI in the United States was conducted using the search terms (urgency urinary incontinence OR urge incontinence OR mixed incontinence OR overactive bladder) AND (burden OR cost OR economic) AND (United States), with limits for English language, publication from 1991 to 2011, humans, and adults (19+ years). Only primary articles of non-neurogenic UUI in the United States were retained. Seven studies were identified that included data on the economic burden of UUI in the United States from a societal and patient perspective. Although estimates of the total economic burden of UUI include direct, indirect, and intangible costs, none of the 7 U.S. studies included all of these cost components. Furthermore, the costs of UUI often could not be fully extracted from the costs of OAB, which include patients with and without UUI, or the costs of other types of UI. The most recent cost analysis incorporated OAB with UUI prevalence rates and data on use of each cost component to calculate the total annual direct costs in 2007 for adults aged ≥ 25 years. The estimated total national cost of OAB with UUI in 2007 was $65.9 billion, with projected costs of $76.2 billion in 2015 and $82.6 billion in 2020. This 2007 estimate was markedly higher than those reported in older studies. Direct costs are the main driver of the overall cost of UUI in the United States. Studies that assessed patient costs indicated that the personal costs of routine care items for UUI and MUI represent a meaningful contribution to the overall economic burden of these conditions. These substantial personal expenditures may explain why patients reported that they were willing to pay considerable amounts for a treatment that would reduce the frequency of their UUI episodes. UUI in the United States is associated with a substantial economic burden from both a societal and patient perspective. Studies evaluating the impact of interventions that reduce the frequency of UUI episodes on the overall economic burden of UUI are warranted.

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... It represents a chronic condition with a significant impact on health-care cost. The economic impact in the United States (US) alone is calculated around 82.6 billion dollars per year, causing a plethora of healthcare concerns [4][5][6]. ...
... Multiple studies have presented good results with BoNT-A in the treatment of refractory OAB with reported success rates of patients showing significant improvement -varying between 57% and 88% -in bladder function regarding voiding diary data, urodynamic parameters, and subjective symptoms like quality of life. However, the mean duration of the effect lasts only about 5-7 months (range [5][6][7][8][9][10][11] with the need to repeat treatment [21][22][23][24]. A prospective cohort study showed that the improvement was maintained after multiple injection, although a dropout rate of 25% was seen after the first injection, increasing to 37% after 2 injections [25]. ...
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Introduction: Sacral Neuromodulation (SNM) is a minimally invasive treatment for OAB patients following failure of conventional interventions. Patient selection, lead placement, and testing technique are important pillars in optimizing success rates. Areas covered: A comprehensive literature search was conducted on 'sacral neuromodulation' and 'overactive bladder.' There was no date restriction, with the last search dated 31 May 2021. Patient selection, lead placement, test phases, safety, efficacy, and available devices are thoroughly discussedLastly, future perspectives will be presented with the anticipated trajectory of sacral neuromodulation over the next five years. Expert opinion/commentary: SNM has proved to be a safe and effective therapy on the short-, medium- and long-term without precluding any other treatment options. In all studies reviewed, no life threatening or major irreversible complications were presented. However, surgical re-intervention rates were high with a median of 33.2% (range: 8-34%) in studies with at least 24 months follow-up. No true consensus could be made regarding prognostic factors. However, optimized lead placement, consequent ideal motor thresholds, and the use of a curved stylet theoretically facilitates reaching maximal success with SNM. Test phase success rates increased to such a level that from a cost-effective point of view, single-stage implants could be considered.Abbreviations: OAB: overactive bladder; SNM: sacral neuromodulation; BoNT-A: Botulinum toxin A; PFM EMG: pelvic floor muscle electromyography; IPG: implantable pulse generator; PNE: percutaneous nerve evaluation; FSTLP: first-stage tined lead procedure; NLUTD: neurogenic lower urinary tract dysfunction; ITT: intention to threat; PPMC: per protocol modified completers; PPC: per protocol completers; AE: adverse event; MRI: magnetic resonance imaging; RCT: randomized controlled trial.
... diagnostic tests, inpatient and outpatient care, laundry, drug treatment, behavioral treatment, etc.) and indirect costs (expenditure for paid or unpaid caregivers) constitute only 4% of the total UI cost (8). The majority of the studies conducted worldwide focus on costs related to overactive bladder and urgency incontinence problems (7,14,15). ...
... In a systematic review, it is indicated that the total national cost of urgecy incontinence in the United States of America (USA) was 65.9 billion USD in 2007, 76.2 billion USD in 2015, and it is estimated to be 82.6 billion USD in 2020, with direct costs being the main portion of the overall cost of urgency incontinence. It is stated that this will increase gradually in the following years (14). The most comprehensive study in the USA was conducted in 1995, and the cost of direct care of UI was calculated as 16.3 billion USD. ...
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Urinary incontinence (UI) is a health problem that affects all individuals physically, mentally, socially and economically. The prevalence of UI ranges between 5-70%. UI creates a serious economic burden on the individual, family, community, and health services. Disease burden is an important parameter in determining the economic burden of UI and often uses Quality Adjusted Life Years (QALY-a tool developed to evaluate the cost-effectiveness of treatments). UI total cost cover all the costs used, lost and include direct and indirect costs. Direct costs consist of costs related to diagnosis, treatment, routine care, and UI outcome costs while routine care costs make up a large portion of UI costs. Indirect costs are the invisible portion of the economic burden of UI, which is very difficult to calculate and is assumed to have a larger share than direct costs. In Turkey, there is no registration system or research yet concerning the UI and its economic burden, and available data is limited to the costs of diagnosis and treatment specified in the Healthcare Implementation Communiqué (SUT). In this review, the disease burden and cost of stress (SUI), urgency (UUI), and mixed urinary incontinence (MUI) have been investigated according to the literature and its current status was determined. Our study has revealed that UI creates a serious economic burden on the individual and the healthcare system, and that first-line healthcare services are key in reducing this burden. For the cost-effective management of UI in Turkey, it is important to determine the economic burden of the disease at the national level, to expose relevant direct and indirect costs, and to employ resources accurately and effectively.
... An estimated 1 billion people worldwide suffer from some form of lower urinary tract dysfunction (LUTd) (1,2). This includes a broad spectrum of conditions in which the apparently simple process of urine storage and voiding is disturbed. ...
... Although generally not life-threatening, LUTd is often detrimental to the patient's quality of life and productivity. The societal costs are accordingly high (1). Current pharmacotherapies for LUTd mainly target contractility of the smooth muscle and urethra. ...
Article
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Lower urinary tract dysfunction (LUTd) represents a major health care problem with a high, unmet medical need. Design of additional therapies for LUTd requires precise tools to study bladder storage and voiding (dys)function in animal models. We developed videocystometry in mice, combining intravesical pressure measurements with high-speed fluoroscopy of the urinary tract. Videocystometry substantially outperforms current state-of-the-art methods to monitor the urine storage and voiding process, by enabling quantitative analysis of voiding efficiency, urethral flow, vesicoureteral reflux, and the relation between intravesical pressure and flow, in both anesthetized and awake, nonrestrained mice. Using videocystometry, we identified localized bladder wall micromotions correlated with different states of the filling/voiding cycle, revealed an acute effect of TRPV1 channel activation on voiding efficiency, and pinpointed the effects of urethane anesthesia on urine storage and urethral flow. Videocystometry has broad applications, ranging from the elucidation of molecular mechanisms of bladder control to drug development for LUTd.
... Differences between experts' and home care nurses' views can be exemplified by the QI bladder continence decline. The experts agreed that this QI is relevant for measuring the quality of home care in Switzerland, supported by scientific evidence demonstrating the substantial economic burden of urinary incontinence (UI) to patients and society [41,42]. In addition, evidence-based guidelines for the management of UI exist. ...
Article
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Background Despite an increasing importance of home care, quality assurance in this healthcare sector in Switzerland is hardly established. In 2010, Swiss home care quality indicators (QIs) based on the Resident Assessment Instrument-Home Care (RAI-HC) were developed. However, these QIs have not been revised since, although internationally new RAI-HC QIs have emerged. The objective of this study was to assess the appropriateness of RAI-HC QIs to measure quality of home care in Switzerland from a public health and healthcare providers’ perspective. Methods First, the appropriateness of RAI-HC QIs, identified in a recent systematic review, was assessed by a multidisciplinary expert panel based on the RAND/UCLA Appropriateness Method taking into account indicators’ public health relevance, potential of influence, and comprehensibility. Second, the QIs selected by the experts were afterwards rated regarding their relevance, potential of influence, and practicability from a healthcare providers’ perspective in focus groups with home care nurses based on the Nominal-Group-Technique. Data were analyzed using median scores and the Disagreement Index. Results 18 of 43 RAI-HC QIs were rated appropriate by the experts from a public health perspective. The 18 QIs cover clinical, psychosocial, functional and service use aspects. Seven of the 18 QIs were subsequently rated appropriate by home care nurses from a healthcare providers’ perspective. The focus of these QIs is narrow, because three of seven QIs are pain-related. From both perspectives, the majority of RAI-HC QIs were rated inappropriate because of insufficient potential of influence, with healthcare providers rating them more critically. Conclusions The study shows that the appropriateness of RAI-HC QIs differs according to the stakeholder perspective and the intended use of QIs. The findings of this study can guide policy-makers and home care organizations on selecting QIs and to critically reflect on their appropriate use.
... Urinary incontinence is known to incur a substantial economic burden. 16 The direct costs of urinary incontinence include those of treatment, managing the condition at home, and buying continence products. 17 Our participants mentioned that saving on incontinence materials can increase costs in other health care domains, such as home care, thereby potentially making any cost savings a false economy. ...
Article
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Based on complaints that patients with urinary incontinence were not receiving the correct medical aids, the Dutch Ministry of Health, Wellbeing, and Sports requested further exploration. This resulted in a new framework based on considering individual activities of daily living when providing continence products. We aimed to explore the expectations of pharmacy staff regarding this new framework for continence care in the Netherlands and to establish the facilitators and barriers associated with that care. In total, 15 participants from 7 different pharmacies participated in 2 focus groups. Data analysis was by thematic content analysis. Pharmacy employees were positive about the idea of considering individual daily activities when providing continence products in the new framework, but they did have some reservations about the feasibility of implementation in daily practice. Barriers to optimal continence care included low reimbursement for patients with incontinence, especially with non-standard needs, and poor communication between the various stakeholders in continence care. Efforts must be extended to review the current reimbursement system and to change the policies and information provided by stakeholders in continence care, before the new framework will make a real impact in clinical practice.
... The economic burden of urge UI in the U.S., for example, was estimated to be $65.9 billion in 2007 with greater than 20% growth projected by 2020. 89 Aging of the U.S. population and economic inflation that has occurred since this estimate may mean the cost is substantially higher today. The impact of obesity and diabetes, together with population growth, is expected to incur an additional $1.24 billion per year in healthcare spending for urolithiasis alone by 2030. ...
Article
Objective To provide a conceptual framework to guide investigations into burdens of noncancerous genitourinary conditions (NCGUCs), which are extensive and poorly understood. Methods The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) convened a workshop of diverse, interdisciplinary researchers and health professionals to identify known and hidden burdens of NCGUCs that must be measured to estimate the comprehensive burden. Following the meeting, a subgroup of attendees (authors of this article) continued to meet to conceptualize burden. Results The Hidden Burden of Noncancerous Genitourinary Conditions Framework includes impacts across multiple levels of well-being and social ecology, including individual (i.e., biologic factors, lived experience, behaviors), interpersonal (e.g., romantic partners, family members), organizational/institutional (e.g., schools, workplaces), community (e.g., public restroom infrastructure), societal (e.g., health care and insurance systems, national workforce/economic output), and ecosystem (e.g., landfill waste) effects. The framework acknowledges that NCGUCs can be a manifestation of underlying biological dysfunction, while also leading to biological impacts (generation and exacerbation of health conditions, treatment side effects). Conclusions NCGUCs confer a large, poorly understood burden to individuals and society. An evidence-base to describe the comprehensive burden is needed. Measurement of NCGUC burdens should incorporate multiple levels of well-being and social ecology, a life course perspective, and potential interactions between NCGUCs and genetics, sex, race, and gender. This approach would elucidate accumulated impacts and potential health inequities in experienced burdens. Uncovering the hidden burden of NCGUCs may draw attention and resources (e.g., new research and improved treatments) to this important domain of health.
... The implications of UI for quality of life (QoL) are extensive and may include depression, anxiety, impaired sexual function, avoidance of social interactions, and in severe cases, even loss of independence [4]. Furthermore, UI has substantial economic ramifications from both a societal and a patient perspective [5]. ...
Article
Introduction and hypothesisVitamin D receptors are found in skeletal and smooth muscle cells throughout the body, specifically in the bladder detrusor muscle. We reviewed the current literature on the association between vitamin D deficiency and urinary incontinence (UI), and whether vitamin D supplementation plays a role in the treatment of UI symptoms.Methods We performed a scoping review of all available studies. PubMed, Google Scholar, and PEDro databases were searched from inception until August 2020 with the keywords “urinary incontinence,” “pelvic floor disorders,” “lower urinary tract symptoms,” “overactive bladder,” and various terms for vitamin D. No language restrictions were imposed. The reference lists of all retrieved articles were also searched.ResultsThe search revealed 12 studies of different research methodologies after elimination. In 6 out of the 7 cross-sectional studies reviewed, a significant association between vitamin D deficiency or insufficiency and the onset and severity of UI was found. In 2 out of the 3 prospective studies included, no association between vitamin D intake and UI was found; however, both randomized controlled trials that were reviewed found that vitamin D supplementation is effective for the treatment of UI.Conclusions The existing literature supports an association between low levels of serum vitamin D and UI. Initial evidence regarding the effect of vitamin D supplementation on UI is accumulating, yet additional, comprehensive research is warranted to establish these findings.
... During last 5 years, the estimated total cost of UUI in the US increased from $76.2 billion to $82.6 billion. 4 Risk factors for UUI include age, obesity, delivery mode, and, for women, postmenopausal status. 5 The incidence of UUI is also related to long-term smoking and chronic coughing. 6 Polyfluoroalkyl chemicals (PFCs) are a group of artificial fluorinated compounds that have been used widely in human life over the past decades, including in food packaging, clothing, and cosmetics. ...
Article
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Background The artificial fluorinated group of compounds polyfluoroalkyl chemicals (PFCs) has been applied extensively in daily life for decades, and is present in food, drinking water, and indoor dust. The nephrotoxicity of PFCs has been widely studied for its characteristics of being mainly excreted through passing urine and affecting urodynamics. This work aimed to investigate the relationship between PFCs and the occurrence of urge urinary incontinence (UUI) in the United States (US) population. Methods There were 3157 eligible female participants retrieved from the National Health and Nutrition Examination Survey (NHANES) between 2007 and 2014. A logistic regression model was used to examine the relationship between UUI and eight kinds of PFCs. The dose–response relationship was investigated through restricted cubic spline analysis in this retrospective study. Results Of the 3157 eligible female participants, 913 self-reported a history of UUI. Total PFCs, perfluorohexane sulfonic acid (PFHS), 2-(N-methyl-perfluorooctane sulfonamido) acetate (MPAH), and perfluorononanoic acid (PFNA) correlated positively with the occurrence of UUI after adjusting for age, race, education, vigorous recreational activities, hypertension, diabetes, body mass index (BMI), creatinine, and estimated glomerular filtration rate (eGFR). Based on the results of sub-group analysis, the increasing tertiles contained odds ratios [OR; 95% confidence intervals (CI)] of 1.25 (95% CI, 1.03–1.51, p = 0.026) and 1.56 (95% CI, 1.29–1.89, p < 0.001) for total PFCs compared with the lowest tertile. The OR for PFHS, MPAH, and PFNA were 1.75, 1.71, and 1.41 respectively, in the highest tertile. Conclusion This study investigated the relationship between PFCs and UUI in female and found total PFCs, PFHS, MPAH, and PFNA were positively correlated with the risk of UUI. The results will contribute to developing individualized treatment for female patients suffering UUI.
... Dysfunction of the urinary bladder can present as urinary incontinence, neurogenic bladder, or urinary retention. These disorders afflict millions of people worldwide and dramatically impact quality of life [1,2]. In many cases, bladder dysfunction is caused by damage to the nerves that supply the LUT. ...
Article
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The autonomic nervous system derives from the neural crest (NC) and supplies motor innervation to the smooth muscle of visceral organs, including the lower urinary tract (LUT). During fetal development, sacral NC cells colonize the urogenital sinus to form pelvic ganglia (PG) flanking the bladder neck. The coordinated activity of PG neurons is required for normal urination; however, little is known about the development of PG neuronal diversity. To discover candidate genes involved in PG neurogenesis, the transcriptome profiling of sacral NC and developing PG was performed, and we identified the enrichment of the type 3 serotonin receptor (5-HT3, encoded by Htr3a and Htr3b). We determined that Htr3a is one of the first serotonin receptor genes that is up-regulated in sacral NC progenitors and is maintained in differentiating PG neurons. In vitro cultures showed that the disruption of 5-HT3 signaling alters the differentiation outcomes of sacral NC cells, while the stimulation of 5-HT3 in explanted fetal pelvic ganglia severely diminished neurite arbor outgrowth. Overall, this study provides a valuable resource for the analysis of signaling pathways in PG development, identifies 5-HT3 as a novel regulator of NC lineage diversification and neuronal maturation in the peripheral nervous system, and indicates that the perturbation of 5-HT3 signaling in gestation has the potential to alter bladder function later in life.
... While they have a benign nature, they can lead to falls and fractures -perhaps at least in part because patients get up at night to void and/or secondary to treatment (Moga et al., 2013). Moreover, they cause a considerable economic burden to the patient and society (Coyne et al., 2014). This article will not discuss LUTS occurring in the context of a urinary tract infection. ...
Chapter
The urinary bladder and urethra form a functional unit to store and expel urine. Relevant disorders include the overactive and underactive bladder syndromes, stress urinary incontinence and bladder pain syndrome. Nocturia is a bothersome symptom that has urological and non-urological causes. Several muscarinic receptor antagonists and β3-adrenoceptor agonists are clinically available for the symptomatic treatment of overactive bladder syndrome; however, few patients find the efficacy/tolerability ratio acceptable to stay on treatment for a long time. Few medical treatments have been approved for stress urinary incontinence, which is largely managed by physiotherapy and surgery. Dedicated treatments for underactive bladder syndrome and bladder pain syndrome are largely lacking. Many drug targets have been proposed including various cytokines and growth factors, receptors, enzymes, transporters and ion channels. Drug targets at the cellular level include smooth muscle, urothelium, interstitial cells and afferent and efferent nerve endings. Clinical development of treatments for functional disorders of the lower urinary tract remains challenging, in part due to limited proven validity of animal models and in part due to a typically large placebo component in the clinical response to a given treatment.
... Patients reported that UUI interferes with their daily activities, such as work and household duties, and their recreational life, such as sport, hobbies and traveling [5,6,7,8]. Current evidence demonstrates the substantial economic burden of UUI to patients and society [8,9]. ...
Article
Introduction and hypothesisUUI co-exists with numerous health conditions, having a substantial negative impact on health-related quality of life and mental health. Cognitive-behavioral therapy (CBT) could help patients manage these problems by changing the way they think and behave.Methods We carried out a systematic review of the literature assessing the modalities and effects of CBT as a stand-alone strategy, without adding PFMT, on symptoms and clinical signs, in women with UUI. Our secondary objective was to report modalities and effects of CBT on health-related quality of life, psychological symptoms and patient-reported satisfaction. The PRISMA methodology was used to carry out this systematic review. A literature search was conducted in PubMed, PEDro, Web of Science and Cochrane Library databases from inception to December 2020. The PICO approach was used to determine the eligibility criteria.ResultsTwelve papers were included in the present review which showed beneficial effects on both symptom severity (p < 0.05) and more subjective areas such as quality of life, psychological symptoms or patient satisfaction level (p < 0.05), respectively). However, results on the effectiveness of CBT on clinical signs remains conflicting.Conclusion Based on the available literature, this review suggested a high level of evidence for the effectiveness of CBT on symptom severity and a moderate level of evidence for the effectiveness of CBT on quality of life, psychological symptoms and patient satisfaction. However, we highlighted no evidence for the effects of CBT on clinical signs.
... Women often experience UI as embarrassing and humiliating, resulting in loss in quality of life [8]. UI also causes considerable socio-economic costs [9,10]. ...
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Introduction and hypothesis Urinary incontinence (UI) is a common complaint for post-partum women. Reported prevalence and incidence figures show a large range due to varying study methodology. The crude prevalence of post-partum UI may differ when accounting for bother. Precise prevalence and incidence figures on (bothersome) UI are of relevance for health care providers, research planning, and policy makers. Therefore, we conducted a systematic review and meta-analysis to investigate the prevalence and incidence of UI in post-partum women in the Western world for relevant subgroups and assessed experienced bother in relation to UI. Methods Observational studies, published between January 1998 and March 2020 and reporting on prevalence and incidence between 6 weeks and 1 year post-partum, were included, regardless of type of UI or setting. We used a random effects model with subgroup analyses for post-partum period, parity and subtype of UI. Results The mean (weighted) prevalence based on 24 included studies, containing a total of 35.064 women, was 31.0%. After an initial drop in prevalence at 3 months post-partum, prevalence rises up to nearly the same level as in the third trimester of pregnancy at 1 year post-partum (32%). Stress UI (54%) is the most prevalent type. UI prevalence is equal among primi- and multiparous women. Experienced bother of UI is heterogeneously assessed and reported to be mild to moderate. Conclusions Post-partum UI is highly prevalent in women in the Western world. After an initial drop it rises again at 1 year post-partum. Experienced bother is mild to moderate.
... Moreover, to some extent, environmental or genetic factors do not appear to affect UI occurrence. Because average life expectancy is increasing in many parts of the world, the global economic burden of UI is projected to further increase and continue to affect public health [31]. ...
Article
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Objectives: Population-level data are lacking for urinary incontinence (UI) in Central and Eastern European countries. Therefore, the objective of this study was to estimate the prevalence, bother, and behavior regarding treatment for UI in a population-representative group of Polish adults aged ≥ 40 years. Methods: Data for this epidemiological study were derived from the larger LUTS POLAND project, in which a group of adults that typified the Polish population were surveyed, by telephone, about lower urinary tract symptoms. Respondents were classified by age, sex, and place of residence. UI was assessed with a standard protocol and established International Continence Society definitions. Results: The LUTS POLAND survey included 6005 completed interviews. The prevalence of UI was 14.6-25.4%; women reported a greater occurrence compared with men (p < 0.001). For both sexes, UI prevalence increased with age. Stress UI was the most common type of UI in women, and urgency UI was the most prevalent in men. We did not find a difference in prevalence between urban and rural areas. Individuals were greatly bothered by UI. For women, mixed UI was the most bothersome, whereas for men, leak for no reason was most annoying. More than half of respondents (51.4-62.3%) who reported UI expressed anxiety about the effect of UI on their quality of life. Nevertheless, only around one third (29.2-38.1%) of respondents with UI sought treatment, most of whom received treatment. Persons from urban and rural areas did not differ in the degrees of treatment seeking and treatment receiving. Conclusion: Urinary incontinence was prevalent and greatly bothersome among Polish adults aged ≥ 40 years. Consequently, UI had detrimental effects on quality of life. Nonetheless, most affected persons did not seek treatment. Therefore, we need to increase population awareness in Poland about UI and available treatment methods, and we need to ensure adequate allocation of government and healthcare system resources.
... In this study, we explore the potential and the limitations of HCD for risk adjustment of the Swiss RAI-HC QIs by taking the outcome "worsening or onset of urinary incontinence (UI)", measured with the RAI-HC QI bladder incontinence, as an exemplary QI. We chose the QI bladder incontinence because UI implies a substantial economic burden for the health care system and is a major health problem for home care clients with a profound influence on physical and psychosocial well-being [27,28]. Furthermore, the QI addresses not only a relevant outcome but also a common quality problem. ...
Article
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Quality indicators (QIs) based on the Resident Assessment Instrument-Home Care (RAI-HC) offer the opportunity to assess home care quality and compare home care organizations’ (HCOs) performance. For fair comparisons, providers’ QI rates must be risk-adjusted to control for different case-mix. The study’s objectives were to develop a risk adjustment model for worsening or onset of urinary incontinence (UI), measured with the RAI-HC QI bladder incontinence, using the database HomeCareData and to assess the impact of risk adjustment on quality rankings of HCOs. Risk factors of UI were identified in the scientific literature, and multivariable logistic regression was used to develop the risk adjustment model. The observed and risk-adjusted QI rates were calculated on organization level, uncertainty addressed by nonparametric bootstrapping. The differences between observed and risk-adjusted QI rates were graphically assessed with a Bland-Altman plot and the impact of risk adjustment examined by HCOs tertile ranking changes. 12,652 clients from 76 Swiss HCOs aged 18 years and older receiving home care between 1 January 2017, and 31 December 2018, were included. Eight risk factors were significantly associated with worsening or onset of UI: older age, female sex, obesity, impairment in cognition, impairment in hygiene, impairment in bathing, unsteady gait, and hospitalization. The adjustment model showed fair discrimination power and had a considerable effect on tertile ranking: 14 (20%) of 70 HCOs shifted to another tertile after risk adjustment. The study showed the importance of risk adjustment for fair comparisons of the quality of UI care between HCOs in Switzerland.
... Evidence from the economic burden of disease studies in both economically developed and developing countries continues to be used to advocate for increased investments in health development [20][21][22][23][24][25][26][27][28][29][30][31][32][33] . The WHO Regional Office for Africa (WHO/AFRO) report titled A Heavy Burden: The Productivity Cost of Illness in Africa, contains useful aggregated economic evidence for use in advocacy at global and regional forums 34 ...
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Background: The Republic of Mauritius had a total of 422,567 disability-adjusted life years (DALYs) from all causes in 2019. This study aimed to estimate the monetary value of DALYs lost in 2019 from all causes in Mauritius and those projected to be lost in 2030; and to estimate the monetary value of DALYs savings in 2030 if Mauritius were to attain the national targets related to five targets of the United Nations Sustainable Development Goal 3 on good health and well-being. Methods: The human capital approach was used to monetarily value DALYs lost from 157 causes in 2019. The monetary value of DALYs lost in 2019 from each cause was calculated from the product of net gross domestic product (GDP) per capita in Mauritius and the number of DALYs lost from a specific cause. The percentage reductions implied in the SDG3 targets were used to project the monetary values of DALYs expected in 2030. The potential savings equal the monetary value of DALYs lost in 2019 less the monetary value of DALYs expected in 2030. Results: The DALYs lost in 2019 had a total monetary value of Int$ 9.46 billion and a mean value of Int$ 22,389 per DALY. Of this amount, 84.2% resulted from non-communicable diseases; 8.7% from communicable, maternal, neonatal, and nutritional diseases; and 7.1% from injuries. Full attainment of national targets related to the five SDG3 targets would avert DALYs losses to the value of Int$ 2.4 billion. Conclusions: Diseases and injuries cause a significant annual DALYs loss with substantive monetary value. Fully achieving the five SDG3 targets could save Mauritius nearly 8% of its total GDP in 2019. To achieve such savings, Mauritius needs to strengthen further the national health system, other systems that tackle the social determinants of health, and the national health research system.
... It is estimated that almost a quarter of women worldwide will suffer from UI in their lifetime (15), and the cost of UI treatment in the USA alone is between $19.5-$76 billion (16). As the most common type, accounting for approximately half of UI, SUI is characterized by involuntary urination due to increased intra-abdominal pressure, which significantly impacts the individual's ability to exercise, as well as their mental health (4,5,17). ...
Article
With the increasing prevalence of obesity worldwide, obesity-related female stress urinary incontinence (FSUI) has become a key health problem. Recent studies indicated that FSUI is primarily caused by obesity-related pathological changes, such as fat droplet deposition, and results in pelvic floor nerve, vascular, and urethral striated muscle injury. Meanwhile, treatments for obesity-associated FSUI (OA-FSUI) have garnered much attention. Although existing OA-FSUI management strategies, including weight loss, pelvic floor muscle exercise, and urethral sling operation, could play a role in symptomatic relief; they cannot reverse the pathological changes in OA-FSUI. The continued exploration of safe and reliable treatments has led to regenerative therapy becoming a particularly promising area of researches. Specifically, micro-energy, such as low-intensity pulsed ultrasound (LIPUS), low-intensity extracorporeal shock wave therapy (Li-ESWT), and pulsed electromagnetic field (PEMF), have been shown to restore the underlying pathological changes of OA-FSUI, which might be related by regulation endogenous stem cells (ESCs) to restore urine control function ultimately in animal experiments. Therefore, ESCs may be a target for repairing pathological changes of OA-FSUI. The aim of this review was to summarize the OA-FSUI-related pathogenesis, current treatments, and to discuss potential therapeutic options. In particular, this review is focused on the effects and related mechanisms of micro-energy therapy for OA-FSUI to provide a reference for future basically and clinical researches.
... Female urinary incontinence, OAB and other LUTS are highly prevalent conditions with a profound influence on well-being and QOL. [1][2][3][4][5] In Japan, a 2002 survey estimated OAB prevalence to be 12.4% (11% in women, 14% in men), increasing with age. 6 In a large-scale nationwide epidemiological survey of randomly selected Japanese men and women aged ≥40 years, 15% experienced a negative impact on daily life from LUTS, although just 3% of the whole sample sought medical care. ...
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Objective To confirm if mirabegron 50 mg shows efficacy in women with overactive bladder and either urgency urinary incontinence or mixed urinary incontinence versus placebo. Methods Post-hoc analyses were carried out using pooled data from a Japanese phase IIb and a phase III study. The primary efficacy end-point was baseline to end-of-treatment change in the mean number of micturitions/24 h. The secondary end-points were changes in the mean voided volume/micturition, mean number of urgency and incontinence episodes/24 h, and mean number of nocturia episodes/night. Other end-points were quality of life and incontinence normalization rates. Results Women with urgency urinary incontinence (placebo n = 204, mirabegron n = 214) and mixed urinary incontinence (placebo n = 122, mirabegron n = 139) were included. Change in mean micturitions/24 h at end-of-treatment for mirabegron was statistically significant versus placebo in both populations; the effect size increased over time. For all secondary end-points, median changes for mirabegron were statistically significant versus placebo at end-of-treatment, except for nocturia for the urgency urinary incontinence population and urgency for the mixed urinary incontinence population. Mirabegron showed larger improvements versus placebo in all quality-of-life domains, except for general health perception in the urgency urinary incontinence population. Incontinence normalization rates for mirabegron were 47.2% and 49.6% in the urgency urinary incontinence and mixed urinary incontinence populations, respectively, versus 42.6% and 39.3% for placebo. Conclusions Mirabegron 50 mg significantly improved key overactive bladder symptoms versus placebo in women with urgency urinary incontinence, and it also improved most overactive bladder symptoms, including micturition frequency, in patients with mixed urinary incontinence. These findings support the benefits of using mirabegron in the female overactive bladder wet population.
... Local estrogen treatment was protective in cases of pelvic floor disorders in several studies. [16][17][18] However, it is uncertain whether LET is beneficial in postmenopausal women with POP. With the lack of evidence and as none of the available studies reported symptoms and signs associated with POP, but mainly reported symptoms associated with vaginal atrophy, our research dealt with exactly this unresearched area. ...
Article
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Objective: To evaluate if locally applied vaginal estrogen affects prolapse-associated complaints compared to placebo treatment in postmenopausal women prior to surgical prolapse repair. Design: Randomised, double-masked, placebo-controlled, multicenter study. Setting: Urogynaecology unit at the Medical University of Vienna and University Hospital of Tulln. Population: Postmenopausal women with symptomatic pelvic organ prolapse and planned surgical prolapse repair. Methods: Women were randomly assigned local estrogen cream or placebo cream 6 weeks preoperatively. Main outcome measures: Primary outcome was differences in subjective prolapse-associated complaints after 6 weeks of treatment prior to surgery assessed with the comprehensive German pelvic floor questionnaire. Secondary outcomes included differences in other pelvic floor associated complaints (bladder, bowel, sexual function). Results: Out of 120 randomised women 103 (86%) remained for final analysis. After 6 weeks of treatment prolapse domain score did not differ between the estrogen and the placebo group (4.4 ± 0.19 vs. 4.6 ± 0.19; mean difference: - 0.21; 95%CI: -0.74 to 0.33; P=.445). Multivariate analysis, including only women with intervention, showed that none of the confounding factors modified response to estradiol. Conclusions: These results demonstrate that preoperative locally applied estrogen does not ameliorate prolapse-associated symptoms in postmenopausal women with symptomatic pelvic organ prolapse.
... PFD is common [16,17], adversely impacts women's wellbeing [1,3], and has a major economic burden for women and healthcare organisations [30,31]. Therefore, PFD prevention is important for women and services alike. ...
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Background The study aimed to explore: • pregnant women’s and healthcare professionals’ perspectives on provision of individual risk scores for future Pelvic Floor Dysfunction (PFD), • the feasibility of providing this during routine maternity care, • actions women might take as a result of knowing their PFD risk. Methods Qualitative study. Setting: UK NHS Health Board. Participants: Pregnant women ( n = 14), obstetricians ( n = 6), midwives ( n = 8) and physiotherapists ( n = 3). A purposive sample of pregnant women and obstetric healthcare professionals were introduced to the UR-CHOICE calculator, which estimates a woman’s PFD risk, and were shown examples of low, medium and high-risk women. Data were collected in 2019 by semi-structured interview and focus group and analysed using the Framework Approach. Results Women’s PFD knowledge was limited, meaning they were unlikely to raise PFD risk with healthcare professionals. Women believed it was important to know their individual PFD risk and that knowledge would motivate them to undertake preventative activities. Healthcare professionals believed it was important to discuss PFD risk, however limited time and concerns over increased caesarean section rates prevented this in all but high-risk women or those that expressed concerns. Conclusion Women want to know their PFD risk. As part of an intervention based within a pregnant woman/ maternity healthcare professional consultation, the UR-CHOICE calculator could support discussion to consider preventative PFD activities and to enable women to be more prepared should PFD occur. A randomised controlled trial is needed to test the effectiveness of an intervention which includes the UR-CHOICE calculator in reducing PFD.
... Urinary incontinence (UI) affects quality of life [1] and leads to complications including incontinence-associated dermatitis [2], urinary tract infections [3,4], and sexual dysfunction in adults [5,6]. The estimated US national cost of UI was $65.9 billion in 2007 and expected to increase to $82.6 billion in 2020 [7]. Epidemiology of UI has primarily focused on women, with recent data indicating that UI affects nearly half of US women [8]. ...
Article
Background Male urinary incontinence (UI) affects quality of life and leads to a significant burden to the health care system. However, the contemporary prevalence and recent trends in UI and its subtypes among US men remain unknown. Objective We evaluated 20-yr trends in the prevalence of UI and its subtype in US men aged ≥20 yr. Design, setting, and participants A serial, cross-sectional analysis of the US nationally representative data from the National Health and Nutrition Examination Survey among men from 2001 to 2020. Outcome measurements and statistical analysis Prevalence of any, stress, urgency and overflow UI were derived. The frequency of UI was assessed in four categories: less than one time per month, a few times per month, a few times per week, and every day and/or night. All analyses were conducted using sample weights, stratification, and clustering of the complex sampling design. Sociodemographic and lifestyle correlates of UI over time were identified using multivariable logistic regressions. Results and limitations Data on 22 994 US men (mean age, 46.6 yr [standard error, 0.20]; weighted population, 848 642 150) were analyzed. The prevalence of any UI increased from 2001–2002 (11.5% [95% confidence interval {CI}, 10.0–13.0]) to 2017–2020 (19.3% [95% CI, 17.2–21.3]), driven by urgency (from 9.0% [95% CI, 7.5–10.4]) to 15.2% [95% CI, 13.4–16.9]) and overflow UI (from 3.3% [95% CI, 2.7–4.0] to 5.5% [95% CI, 4.5–6.4]; all p for trend < 0.01). UI affects 38.5% US men ≥60 yr of age, with increasing trends in urgency and overflow UI and a decreasing trend in stress UI (all p for trend < 0.05). Racial/ethnic disparities were noted, with patterns differed by UI subtype. Compared with non-Hispanic White, non-Hispanic Black men were more likely to report urgency UI (odds ratio [OR], 1.94 [95% CI, 1.71–2.20]). Hispanic men were more likely to report urgency UI (OR, 1.33 [95% CI, 1.14–1.56]), but less likely to report stress (OR, 0.74 [95% CI, 0.56–0.98]) and overflow (OR, 0.75 [95% CI, 0.58–0.98]) UI. Men with higher body mass index and current smokers were more likely to report any, stress, and urgency UI than their counterparts. A higher prevalence of any UI was found in men with low family poverty ratios and chronic diseases, and those who were physically inactive. Conclusions From 2001 to 2020, the overall prevalence of UI increased among US men, particularly for urgency and overflow UI. Patient summary In this report, we looked at the prevalence of urinary incontinence among US men in a nationally representative sample. We found that urinary incontinence increased in the past 20 yr driving by the urgency and overflow urinary incontinence.
... Overactive Bladder (OAB) is a subjective, symptom-based syndrome defined by an urgent desire to void and often includes increased urinary frequency and/or nocturia [1]. This condition impairs the quality of life of millions of individuals [2], and is responsible for a substantial economic burden [3]. Medical treatments for OAB have limited long-term efficacy and are poorly tolerated [4,5]. ...
Article
In this study, an ultrasound-based bladder shape nomogram was developed using data from women without overactive bladder (OAB) and tested in women with OAB to identify irregular bladder shapes. The goal was development of a nomogram that can ultimately be used for non-invasive identification of a bladder shape-associated OAB phenotype. Transabdominal 3-dimensional (3D) bladder ultrasound images were collected at 1-minute intervals during urodynamics studies and at 5-10-minute intervals during oral hydration studies. These prospective studies enrolled women with and without OAB based on International Consultation on Incontinence questionnaire on OAB (ICIq-OAB) question 5a (OAB 5a≥2, without OAB 5a<2). Bladder perimeters were manually traced and refined using GE 4D-View software. Nomograms for the transverse, sagittal and coronal perimeter-volume relationships were developed for women without OAB. A power model was used to approximate upper and lower nomogram bounds with 95% confidence intervals. Nomograms were tested using data from women with OAB, and each participant was classified as having an irregular bladder shape based on the number of perimeter values outside the nomogram bounds. Nomograms were developed using 533 images from 27 women without OAB (14 from urodynamics and 13 from hydration studies) and were tested using 264 images from 24 women with OAB (16 urodynamics and 8 hydration). The sagittal perimeter nomogram provided the best results, with irregular sagittal perimeters identified in 6/24 (25%) women with OAB and 0/27 (0%) without OAB. An irregular sagittal perimeter was significantly associated with OAB (P<0.05). Ultrasound-based nomograms may enable feasible, non-invasive identification of a subgroup of women with bladder shape-associated OAB.
... OAB accounts for about $750 of healthcare spending per person per year or about 5% of total healthcare costs based on a systematic literature review [9]. The total cost of OAB in the USA is estimated to be $82.6 billion in 2020 [10]. ...
Article
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Purpose of Review To evaluate recent literature on combination and novel pharmacologic therapies for overactive bladder (OAB). Recent Findings Combination therapies demonstrating greater efficacy than monotherapy include combination anticholinergics, anticholinergic plus β-3 agonist, and anticholinergic with behavioral modification, percutaneous tibial nerve stimulation, or sacral neuromodulation. Promising novel therapies include new bladder selective anticholinergics, new β-3 agonists, and gabapentin. Summary OAB is a symptom complex caused by dysfunction in the interconnected neural, muscular, and urothelial systems that control micturition. Although several therapeutic targets and treatment options exist, complete resolution is not always achieved, discontinuation rate for medical therapy is high, and few patients subsequently progress to third-line treatment options. Recent literature suggests combination therapy diversifying therapeutic targets is more effective than targeting a single pathway and novel treatments targeting additional pathways have promising results.
... otras investigaciones se justifica su aplicación en eventos como la incontinencia urinaria dado efecto negativo que sobre la salud ejerce la incontinencia urinaria. 42,44,45 La autopercepción de salud es un medidor del estado de salud y un predictor de futuros resultados adversos, que anticipa el riesgo de mortalidad, de eventos mórbidos y la disminución funcional, donde es confirmado el impacto que tiene la incontinencia urinaria en las personas mayores. 46 Existen varios instrumentos que miden la calidad de vida en la incontinencia urinaria, en nuestro estudio usamos el "cuestionario de calidad de vida en la incontinencia urinaria" (modificado por Potenziani" -Hunt-McKenna, Health Policy 1992), empleado en la clínica y aprobado por consenso, es sencillo de aplicar y puede ser realizado en breve tiempo. ...
Article
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RESUMEN Objetivo: Caracterizar las personas mayores que acudieron a la "Clínica de Incontinencia Urinaria", en el período comprendido entre enero y diciembre de 2015, del "Centro de Investigaciones sobre Longevidad, Envejecimiento y Salud", (CITED). Método: Estudio observacional descriptivo de corte transversal, universo constituido por 168 adultos mayores Resultados: Predomino el sexo femenino y el grupo de edades entre 70 y 79 años, el 47% presentó dificultad en las Actividades Básicas de la Vida Diaria. (ABVD) y el 78, 6 en las Actividades Instrumentadas (AIVD). Los diuréticos eran consumidos por el 66, 2%, la diabetes represento el 56, %, seguido por la osteoartrosis para el 50, 6% y la hipertensión arterial para el 49, 4%. La comorbilidad estuvo presente en el 95,2 % de los casos. La autopercepción de salud y calidad de vida, fue regular y mala en el 85,1(143). Predominó la incontinencia urinaria de urgencia para un 28, 6% (48), un 84, 6% (142) recibieron técnicas de modificación conductual y recibieron tratamiento quirúrgico el 55, 4%. Conclusiones: El perfil de paciente que se atiende en este servicio, es una mujer, entre 70 y 79 años, con afectación de las AIVD, que toma diuréticos, diabética y con
... Equally as burdensome are the physiological effects of UI and the direct impact on QOL [18]. A review indicated that the financial burden of outlaying costs for a never-ending supply of continence products can escalate individual stress levels, as does the personal shame of living with UI [19]. ...
Article
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Introduction Pelvic floor exercises are effective in the treatment of urinary incontinence (UI) and are routinely prescribed, along with bladder training, by primary healthcare providers as first line conservative management. Mobile phone applications are increasingly popular within the healthcare setting and can provide opportunities for patients to complete treatments at home. To date, there has not been a systematic review examining outcomes from randomised controlled trials on the effectiveness of mobile applications to improve UI. Methods A systematic review of randomized controlled trials evaluating the effectiveness of mobile applications to improve UI was carried out according to the PRISMA reporting guidelines. The online databases MEDLINE, Embase, PsychINFO, CINAHL, Web of Science, Scopus, The Cochrane Library, Joanna Briggs Institute (JBI), Google Scholar were searched for papers published between 2007 to 2020. Keywords and MeSH terms were used to identify relevant English language studies. The quality and risk of bias within included studies was assessed by two independent reviewers, RCT JBI critical appraisal tool. Due to heterogeneity in the outcome of studies, a meta-analysis of the data could not be conducted. Findings Four studies reported an improvement in the outcome assessed post-intervention, suggesting that using mobile phone applications for pelvic floor muscle training (PFMT) was an acceptable and valid intervention to improve UI. Conclusion Mobile applications for PFMT indicated that increase adherence to treatment and decrease UI. The integration of this treatment modality into current practice is recommended. Mobile phone applications for PFMT show promise in the conservative management of UI. Further research is required to support the use of this technology in the conservative management of UI.
... Direct costs to patients exceed 8B, with the remaining costs dedicated to diagnosis and treatment [11]. Moreover, more recent data estimates that UI underlies $82.6B in annual total cost as related to direct expenses, incontinence products, and nursing home admissions [12]. ...
Article
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Purpose of Review We review contemporary data to understand the role of pelvic floor muscle training (PFMT) in the physiology, prevention, and treatment of stress and urge urinary incontinence, pelvic organ prolapse, and chronic pelvic pain. In addition, a review of treatment regimens and adjuvant therapies is provided. Recent Findings A large body of literature supports the role of PFMT in the treatment of various PFD. A wide variety of treatment regimens are reported and complicate systematic analysis of related outcomes. Less investigation is available to understand the role of PFMT as an adjuvant therapy. Summary Pelvic floor muscle training is recognized as an effective treatment for a variety of pelvic floor disorders and is supported by large body of research and expert guideline statements. Related investigation is limited by significant variety in treatment protocols, outcome measures, and study methodology and further well-designed trials are helpful.
... There are significant clinical, psychosocial, and financial impacts associated with UI, including depression, anxiety, sexual dysfunction, work impairment, social isolation, and reductions in quality of life. The estimated total national cost of UI in the United States in 2007 was $65.9 billion, with projected costs of $76.2 billion in 2015 and $82.6 billion in 2020 [5]. ...
... Urinary tract infections (UTIs) are one of the most pervasive urological disorders and a substantial yearly socioeconomic burden [1,2]. Women are at a significantly higher risk to contract UTIs than men, with 60% of all women experiencing at least one episode in their lifetime [3]. ...
Article
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Background The lack of a definition of urinary microbiome health convolutes diagnosis of urinary tract infections (UTIs), especially when non-traditional uropathogens or paucity of bacteria are recovered from symptomatic patients in routine standard-of-care urine tests. Here, we used shotgun metagenomic sequencing to characterize the microbial composition of asymptomatic volunteers in a set of 30 longitudinally collected urine specimens. Using permutation tests, we established a range of asymptomatic microbiota states, and use these to contextualize the microbiota of 122 urine specimens collected from patients with suspected UTIs diagnostically categorized by standard-of-care urinalysis within that range. Finally, we used a standard-of-care culture protocol to evaluate the efficiency of culture-based recovery of the urinary microbiota. Results The majority of genitourinary microbiota in individals suspected to have UTI overlapped with the spectrum of asymptomatic microbiota states. Longitudinal characterization of the genitourinary microbiome in urine specimens collected from asymptomatic volunteers revealed fluctuations of microbial functions and taxonomy over time. White blood cell counts from urinalysis suggested that urine specimens categorized as ‘insignificant’, ‘contaminated’, or ‘no-growth’ by conventional culture methods frequently showed signs of urinary tract inflammation, but this inflammation is not associated with genitourinary microbiota dysbiosis. Comparison of directly sequenced urine specimens with standard-of-care culturing confirmed that culture-based diagnosis biases genitourinary microbiota recovery towards the traditional uropathogens Escherichia coli and Klebsiella pneumoniae. Conclusion Here, we utilize shotgun metagenomic sequencing to establish a baseline of asymptomatic genitourinary microbiota states. Using this baseline we establish substantial overlap between symptomatic and asymptomatic genitourinary microbiota states. Our results establish that bacterial presence alone does not explain the onset of clinical symptoms. EDHjECaP7CBMthS1cSEo_nVideo Abstract
... Given the aging population in the US, the prevalence of LUTS is expected to increase in the coming years [6]. Medical expenditures for LUTS have been reported to be as high as $65 billion per year [7], yet many therapeutic options for the treatment of LUTS do not provide long-term symptom relief. Many patients experience a combination of symptoms, so treatment that focuses on a single symptom may result in suboptimal care. ...
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We present a methodology for subtyping of persons with a common clinical symptom complex by integrating heterogeneous continuous and categorical data. We illustrate it by clustering women with lower urinary tract symptoms (LUTS), who represent a heterogeneous cohort with overlapping symptoms and multifactorial etiology. Data collected in the Symptoms of Lower Urinary Tract Dysfunction Research Network (LURN), a multi-center observational study, included self-reported urinary and non-urinary symptoms, bladder diaries, and physical examination data for 545 women. Heterogeneity in these multidimensional data required thorough and non-trivial preprocessing, including scaling by controls and weighting to mitigate data redundancy, while the various data types (continuous and categorical) required novel methodology using a weighted Tanimoto indices approach. Data domains only available on a subset of the cohort were integrated using a semi-supervised clustering approach. Novel contrast criterion for determination of the optimal number of clusters in consensus clustering was introduced and compared with existing criteria. Distinctiveness of the clusters was confirmed by using multiple criteria for cluster quality, and by testing for significantly different variables in pairwise comparisons of the clusters. Cluster dynamics were explored by analyzing longitudinal data at 3- and 12-month follow-up. Five clusters of women with LUTS were identified using the developed methodology. None of the clusters could be characterized by a single symptom, but rather by a distinct combination of symptoms with various levels of severity. Targeted proteomics of serum samples demonstrated that differentially abundant proteins and affected pathways are different across the clusters. The clinical relevance of the identified clusters is discussed and compared with the current conventional approaches to the evaluation of LUTS patients. The rationale and thought process are described for the selection of procedures for data preprocessing, clustering, and cluster evaluation. Suggestions are provided for minimum reporting requirements in publications utilizing clustering methodology with multiple heterogeneous data domains.
Article
Aim: Overactive bladder (OAB) is a common and troublesome condition that can significantly impair quality of life. This review aims to educate providers of obstetrics and gynecology services about available therapies for OAB and what to expect following treatment. Methods: Here, we review published data from studies that have evaluated available treatments for OAB. Relevant articles published over the past 2 decades, including large multicenter trials, were identified through a literature search using PubMed.gov, and the references in those articles were also manually searched to find additional articles. Treatment guidelines and product labels were also reviewed. Results: Behavioral therapy is recommended as a first choice for OAB management; pharmacologic treatment (anticholinergics, β3 -adrenoceptor agonists) as second-line treatment; and onabotulinumtoxinA, peripheral tibial nerve stimulation, and sacral nerve stimulation as third-line therapy for patients refractory or intolerant to first- and second-line treatments. A stepwise approach to treatment through first-, second-, and third-line therapies is recommended, recognizing this may not be appropriate for all patients. Conclusions: To optimize symptom control and set realistic expectations, patients should be carefully monitored and counseled appropriately on available treatment options.
Article
Objectives: This is a protocol for a Cochrane Review (intervention). The objectives are as follows:. To assess the effects of urethral bulking injections for treating stress urinary incontinence in women; and summarise the principal findings of relevant economic evaluations. Copyright © 2021 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Article
INTRODUCTION: Urinary incontinence, the involuntary loss of urine, is a common condition that affects approximately 50% of adult women. This condition increases with age, affecting 10% to 20% of all women and up to 77% of elderly women residing in nursing homes. EVIDENCE ACQUISITION: Systematic data search performed using PubMed/MEDLINE database up to July 20, 2020. Focus was only for English language publications of original studies on urinary incontinence. EVIDENCE SYNTHESIS: Given the basis of published evidence and the consensus of European experts, this study provides an updated overview on clinical applications and surgical procedures of urinary incontinence. CONCLUSIONS: Urinary incontinence is an underestimated health problem. Patients need an overview of their health condition through a detailed anamnestic collection and physical examination to identify the type of incontinence and offer the best treatment.
Article
Background Physical activity and macronutrient intake, important contributors to energy balance, may be independently associated with female urinary incontinence (UI). Methods We evaluated the association of baseline self-reported physical activity and macronutrient intake, via food-frequency questionnaire, with incident UI subtypes after 3 years among 19,741 post-menopausal women in the Women’s Health Initiative Observational Study. Odds ratios (OR) for incident urgency, stress, and mixed UI were calculated using multivariable logistic regression. Results Women who reported total physical activity (MET-hours/week) ≥30 vs <0.1 were 16% less likely to develop urgency UI (OR=0.84; 95% CI 0.70, 1.00) and 34% less likely for mixed UI (OR=0.66; 0.46, 0.95), although linear trends were no longer statistically significant after adjusting for baseline weight and weight change (P-trend=0.15 and 0.16, respectively). The association between physical activity and incident stress UI was less consistent. Higher uncalibrated protein intake was associated with increased odds of incident urgency UI (≥19.4% versus <14.1% of energy intake OR=1.14; 95% CI 0.99, 1.30; P-trend=0.02), while confidence intervals were wide and included 1.0 for calibrated protein intake. Other macronutrients were not associated with urgency UI and macronutrient intake was not associated with incident stress or mixed UI (P-trend>0.05 for all). Conclusions Among post-menopausal women, higher physical activity was associated with lower risk of incident urgency and mixed UI, but not stress UI, independent of baseline weight and weight change. Higher protein intake was associated with increase urgency UI, but no associations were observed between other macronutrient and UI subtypes.
Article
Background Local estrogen therapy (LET) has beneficial effects on genitourinary atrophy; however it is currently unclear if LET improves sexual function in postmenopausal women with pelvic organ prolapse (POP). Aim To evaluate if LET vs placebo results in an improved sexual function in postmenopausal women with symptomatic POP. Methods We performed a secondary analysis of sexual outcomes of a previous randomized controlled trial comparing LET and placebo in 120 postmenopausal women (60/group) with symptomatic POP stage ≥3 and planned prolapse surgery. Women were randomly assigned to receive local estrogen or placebo cream 6 weeks preoperatively. The effect of therapy vs placebo was assessed with ANOVA with interaction effect of time*group and a multivariable linear regression model was built to assess the impact of different variables on sexual function before therapy. Outcomes We evaluated the sexual function score in sexually active women of our study population using the German Pelvic Floor Questionnaire at recruitment time and again after 6 weeks of treatment. Results Among 120 randomized women, 66 sexually active women remained for final analysis. There was no significant difference in the change of the sexual function score over time between the treatment groups (difference in changes in score from baseline to 6 weeks for Estrogen group vs control group was -0.110 with 95% CI -0.364 to 0.144) Multivariable analysis showed that no independent risk factor for unsatisfying sexual function score could be identified. Clinical Implications Based on our results, LET has no beneficial effect on sexual function in postmenopausal women with POP. Strengths and limitations Main strength of our study lies in the study design and in the use of a condition- specific questionnaire. As this is a secondary analysis, this study may be insufficiently powered to identify differences in sexual data between groups. Conclusion LET had no impact on female sexuality in postmenopausal women with POP. Marschalek M-L, Bodner K, Kimberger O, et al. Sexual Function in Postmenopausal Women With Symptomatic Pelvic Organ Prolapse Treated Either with Locally Applied Estrogen or Placebo: Results of a Double-Masked, Placebo-Controlled, Multicenter Trial. J Sex Med 2022;XX:XXX–XXX.
Article
Bladder pathologies, very common in the aged population, have a considerable negative impact on quality of life. Novel targets are needed to design drugs and combinations to treat diseases such as overactive bladder and bladder cancers. A promising new target is the ubiquitous Rho GTPase Rac1, frequently dysregulated and overexpressed in bladder pathologies. We have analyzed the roles of Rac1 in different bladder pathologies, including bacterial infections, diabetes-induced bladder dysfunctions and bladder cancers. The contribution of the Rac1 protein to tumorigenesis, tumor progression, epithelial-mesenchymal transition of bladder cancer cells and their metastasis has been analyzed. Small molecules selectively targeting Rac1 have been discovered or designed, and two of them—NSC23766 and EHT 1864—have revealed activities against bladder cancer. Their mode of interaction with Rac1, at the GTP binding site or the guanine nucleotide exchange factors (GEF) interaction site, is discussed. Our analysis underlines the possibility of targeting Rac1 with small molecules with the objective to combat bladder dysfunctions and to reduce lower urinary tract symptoms. Finally, the interest of a Rac1 inhibitor to treat advanced chemoresistance prostate cancer, while reducing the risk of associated bladder dysfunction, is discussed. There is hope for a better management of bladder pathologies via Rac1-targeted approaches.
Article
Objectives To evaluate the safety and efficacy of the eCoin® - a nickel-sized, primary battery-powered, neuromodulation device for the treatment of urgency urinary incontinence which is implanted in the lower leg in a 20-minute procedure under local anesthesia. A feasibility clinical trial was conducted and the results after one year of treatment with the eCoin are presented. Methods A total of 46 participants with refractory urgency urinary incontinence were included in this prospective, single-arm, open-label study. This study was conducted at seven sites in the United States and New Zealand. Participants in this study were implanted with the eCoin in the lower leg over the tibial nerve and activated after 4 weeks. Bladder diary data and validated quality-of-life instruments, collected at 3, 6, and 12 months post-activation, were compared to baseline values. Results Responders were defined as those who had a ≥50% reduction in reported episodes of urgency urinary incontinence. At 12 months, 65% of participants were considered responders with 26% of participants achieving complete continence. The median number of urgency urinary incontinence episodes per day decreased from 4.2 at baseline to 1.7 at 12 months. Seventy percent of participants reported feeling “better”, “much better”, or “very much better” on the Likert 7-point maximum scale. One participant experienced a related serious adverse event. Conclusions The eCoin is a safe and effective treatment for urgency urinary incontinence associated with overactive bladder syndrome, with significant reduction or complete resolution of symptoms and no significant safety concerns.
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Objective: Describe the medium-term safety of the tension free vaginal tape obturator (TVT-O) procedure in terms of complications, cure and changes in quality of life (QoL) after the surgery. Materials and methods: Descriptive historical cohort that included women over 18 years of age who underwent TVT-O due to objectively proven stress urinary incontinence, urethral hypermobility or mixed urinary incontinence in which the stress component predominated, confirmed on urodynamic testing between July 2013-April 2017, in a reference hospital located in the city of Murcia Spain. Women with previous anti-incontinence surgery, concomitant vaginal surgery and planning pregnancy were excluded. Follow-up was determined for each patient based on the time elapsed between surgery and the time when the research protocol was applied. Complications were stratified according to the modified Clavien-Dindo classification; also we evaluated subjective cure rate, quality of life using the ICIQ-SF score, before and after surgery. Results: The mean age was 52.6 (SD± 10.5) years and 80.1% of patients were at least overweight. The incidence of complications at 12 months was: 8.3% (12/144). We did not detect complications after this period in the followed patients at 24, 36 and 48 months. The subjective cure determined at 12, 24, 36 and 48 months was 62.5% (90/144), 59.09% (55/88), 50.81% (31/61) and 50% (7/14), respectively. There was a significant improvement in quality of life, as determined by the ICQ-SF mean score before and after surgery (13.76[6,34] vs 3.84[5.76]; p<0.05). Conclusions: The TVT-O surgery is a safe therapy associated with a low complication incidence at 12 months, an acceptable subjective cure rate in stress urinary incontinence, and quality-of-life improvement. Classifications of complications related to the insertion of the prosthesis and of those inherent to surgery, such as urinary tract infection, are required.
Article
BACKGROUND Overactive bladder (OAB) is a chronic, age-related disorder seen in 11 % of patients. Symptoms consist of urinary urgency, with or without urinary incontinence, usually with frequency or nocturia. The objective of the present study was to compare the efficacy and side effects of mirabegron and solifenacin as primary therapies in patients with overactive bladder. METHODS This was a prospective interventional study. 100 patients aged between 18 years and 50 years with overactive bladder were included and were assigned into two treatment groups of solifenacin 5 mg or mirabegron 50 mg. They were asked to record the number of micturitions in a day, urgency episodes, incontinence episodes and volume of each micturition. All patients went through a basic workup with blood sugar to rule out diabetes, USG KUB to rule out bladder stones, and urine culture and sensitivity to rule out urinary tract infection (UTI). RESULTS 100 patients with OAB were selected for the study and divided into equal groups, 50 receiving 5 mg solifenacin and 50 receiving 50 mg mirabegron. Both groups increased the mean micturition volume but mirabegron was more effective in increasing the mean micturition in patients with OAB. Both drugs were well tolerated. There was a significant increase in mean micturition volume in mirabegron 50 mg group (by 20.7 + / - 2.2 mL), P < 0.001 whereas in solifenacin group micturition volume was increased to 22.2 + / -0.97 ml). The most common side-effect in the mirabegron group was hypertension and the most common side effect in the solifenacin group was dry mouth. CONCLUSIONS Both mirabegron and solifenacin were effective in controlling the frequency of micturition, decreasing urgency and incontinence episodes and increasing the mean volume of micturition. Mirabegron was more effective than solifenacin in controlling urgency and incontinence episodes and increasing the mean volume of micturition. KEY WORDS Overactive Bladder (OAB), Micturition, Mirabegron, Solifenacin.
Article
Aims: To provide an overview of the barriers and facilitators to overactive bladder (OAB) therapy initiation and adherence. Methods: A PubMed and Embase literature search was conducted to identify barriers to OAB therapy adherence. Results: OAB therapy adherence is associated with improvements in urinary symptoms, and quality of life with reductions in annual costs for OAB-related expenditures. However, adherence rates to behavioral therapies are as low as 32% at 1 year, only 15%-40% of treated patients remain on oral medications at 1 year due to several factors (e.g., inadequate efficacy, tolerability, and cost), and 5%-10% of OAB patients progress to advanced therapies. While some common barriers to therapy adherence are often fixed (e.g., costs, lack of efficacy, time, side effects, treatment fatigue), many are modifiable (e.g., lack of knowledge, poor relationships, negative experiences, poor communication with providers). Patient-centered care may help address some modifiable barriers. Emerging data demonstrate that patient-centered care in the form of treatment navigators improves OAB therapy adherence and progression to advanced therapies in the appropriate patient. Conclusions: There are numerous modifiable barriers to OAB therapy adherence. A patient-centered lens is needed to elicit patient goals, establish realistic treatment expectations, and tailor therapy to improve therapy adherence, optimize outcomes, and reduce healthcare expenditures. Further research is needed to develop and study low-cost, scalable solutions.
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Background & Objective: Urinary incontinence (UI) is a common disease that affects millions of people throughout their lives. It is reported that UI has a considerable economic burden on patients and communities. The aim of this study was to find out the prevalence of urinary incontinence (UI) and its related factors among women living in Birjand city, Iran. Materials & Methods: A cross-sectional study from September 2020 to December 2020 was conducted on women 15 to 70 years living in nine areas of Birjand city. Data were gathered by researcher-made questionnaire and in-person interviews about demographic, obstetrics, and UI (stress, urge, and overflow UI) characteristics. Chi-square test was applied to analyze differences between women with and without UI about risk factors. Results: Of 3028 women (mean age 32.7011.49 years), 828 (27.3%) reported to have UI. The rate of stress, urge, and mixed UI was 18.1%, 3.4%, and 5.9%, respectively. All types of UI were associated with age, education, BMI, chronic cough / dyspnea, constipation, diabetes mellitus, and smoking. Conclusion: Women should be continuously educated by health care providers on the risk factors and activities which can reduce their risk for UI. Further studies on women across the country may help decision makers to measure the regional burden of disease and to plan population-level interventions.
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Objective: To determine the feasibility of performing a randomized controlled trial comparing Pelvic Floor Muscle Training (PFMT) and behavioral advice only for postpartum SUI. Results: A feasibility study was performed with 207 women in 7-16 weeks postpartum at community postpartum clinics. Women reporting SUI were randomized to an intervention group (n=15), which followed an organized PFMT programme for six weeks and a control group (n=14). Control group was advised on routine postnatal care with behavioral advice. Both groups were assessed for QoL using a validated incontinence-quality of life (I-QOL) questionnaire at recruitment and in six weeks. There were 14% (29/207) of women suffering from SUI amongst the study sample. Before intervention there was no difference between I-QOL score in both groups. There was significant improvement (p<0.001) of I-QOL score in the interventional group (PFMT) compared to the control group (routine care with behavioral advice) after six weeks. Studying QOL improvement with this intervention is feasible for an interventional study. If directly inquired by the healthcare provider, women were willing to report, discuss and seek treatment for SUI. Conclusion: SUI is a common postpartum problem in this urban cohort of Lankan women. These women can be effectively treated improving their QOL with PFMT intervention.
Article
Background: Two chemotherapeutic agents used widely in pediatric oncology are vincristine (VCR) and doxorubicin (DOX), which may cause neuropathy and myopathy, respectively. The study hypothesis is that neurotoxic effects of VCR and/or myotoxic effects of DOX affect bladder physiology and manifest clinically as lower urinary tract dysfunction (LUTD). Procedure: Based on a priori power analysis, 161 children divided evenly by gender were recruited. Children aged 5-10 years completed the dysfunctional voiding scoring system (DVSS) survey. The study cohort comprised cancer survivors treated with VCR and/or DOX. Healthy controls were recruited from well-child clinic visits. Exclusion criteria included pelvic-based malignancy, pelvic irradiation, pre-existing LUTD, neurologic abnormalities, and treatment with cyclophosphamide/ifosfamide. DVSS scores and presence of LUTD, defined as DVSS scores above gender-specific thresholds (males ≥9, females ≥6), were compared across cohorts. Results: Median DVSS scores were higher in the study cohort (6 vs. 4, p = .003). Moreover, children in the study cohort were more likely to exceed threshold scores for LUTD (38.8% vs. 21%, p = .014; OR 1.8). Subanalysis by gender revealed female cancer survivors are more likely to report LUTD than controls (57.5% vs. 30%, p = .013, OR 1.9). This did not hold true for males (20% vs. 12.2%, p = .339). Conclusions: Childhood cancer survivors who received VCR and/or DOX reported higher rates of LUTD than controls. Female cancer survivors appear more likely to suffer from LUTD than males. Further study with a positive control cohort of cancer survivors who received non-VCR, non-DOX chemotherapy is underway to elucidate the contribution of a cancer diagnosis to LUTD.
Article
Objectives Women often feel embarrassed about urinary incontinence, hesitate to see a doctor and search the internet to gain information on the disease. The objective of this study was to evaluate the quality of the most viewed YouTubeTM pertaining to female urinary incontinence. Material and Methods : Sixty videos that met the inclusion criteria were assessed by two urologists through Quality Criteria for Consumer Health Information (DISCERN), Journal of the American Medical Association (JAMA) and Video Power Index (VPI) scoring systems. Videos’ image type, video uploaders, general content, length, view counts, date of uploading, comment, like and dislike counts were also recorded and analyzed. Results Forty videos included real and 20 animation images. Nine videos were uploaded directly by physicians, 32 videos by health channels, 14 videos by hospital channels, 2 videos by herbalists and 3 videos by other sources. The mean comment, like and dislike counts of the videos were found as 49.4±172.9, 642.5±2,112.9 and 66.7±192.4. The mean DISCERN score was found as 38.2±11.5, JAMA score as 1.4±0.6 and VPI score as 85.1±12.1. There was no significant difference between physicians and non-physicians and between real and animated videos in terms of DISCERN and JAMA scores (p>0.05). Conclusions The quality of the videos on YouTubeTM pertaining to female urinary incontinence was at an average level. Healthcare professionals should be encouraged for uploading more accurate quality health related contents. Policy makers should develop policies for supervision of the videos uploaded on the internet.
Chapter
Urinary incontinence is very common and affects women of all ages and up to 44–57% of middle-aged women, but still remains one of the most overlooked gynaecological symptoms in the developing countries. It adversely affects the quality of life, and many affected patients do not present for clinical help. This chapter details the assessment and management of women with urinary incontinence in developing countries. Clinical assessment and investigations should be thorough, and the place of urodynamics is discussed in detail. Investigations must be goal-oriented, and urodynamics does not have to be done before initiating treatment. Based on the limited recourses, the chapter emphasises on relatively inexpensive measures that prevent urine incontinence in the first place as proper supervision and management of childbirth, simple lifestyle modifications and pelvic floor exercises. It also recommends using carefully selected surgical interventions as the last recourse. Drugs remain the mainstay in the management of overactive bladder symptoms, and the place of anticholinergic medications and the newly introduced beta-agonists are discussed in detail. Urinary incontinence does not appear to be a priority for healthcare providers in developing countries, and more investment and research is needed to advance practice in the area.
Article
To assess healthcare resource utilization and costs for female patients diagnosed with stress or mixed urinary incontinence (SUI/MUI) compared to a matched cohort of patients without SUI/MUI. We conducted a retrospective matched cohort study of women using the IBM MarketScan research database. Women diagnosed with SUI/MUI between July 1, 2014 and June 30, 2016 were identified using International Classification of Diseases 9 and 10 codes for SUI or MUI with the date of first diagnosis as the index date from which 2‐year postindex healthcare resource use and direct cost data were derived from claims, examined, and compared 1:1 with patients without a SUI/MUI diagnosis, matched by age and Charlson's Comorbidity Index. A total of 68 636 women with SUI/MUI were matched 1:1 with controls. In the 2‐year postindex date, a significantly higher proportion of SUI/MUI patients had ≥1 inpatient visit and ≥1 outpatient visit compared to the control group (inpatient: 18.89% vs. 12.10%, p < 0.0001; outpatient: 88.44% vs. 73.23%, p < 0.0001). Mean primary care visits were significantly higher in SUI/MUI patients compared to controls (7.33 vs. 5.53; p < 0.0001) as were specialist visits (1.2 vs. 0.08; p < 0.0001). Mean all‐cause outpatient costs were higher in SUI/MUI patients compared to controls ($7032.10 vs. $3348.50; p < 0.0001), as were inpatient costs ($3990.70 vs. $2313.70; p < 0.0001). Women with SUI/MUI consume significantly higher medical resources and incur higher costs to payers, compared to women without SUI/MUI. While reasons for this are not fully understood, improved and standardized treatment for women with SUI/MUI may positively affect cost and outcomes.
Article
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Purpose: Despite the importance of alterations in bladder sensation, objective metrics to characterize sensation outside of urodynamics remain limited. A real-time sensation meter enables recording of sensation event descriptors throughout filling. The purpose of this study was to evaluate the differences in sensation event descriptor patterns between normal participants and those with OAB. Methods: Normal and OAB participants were enrolled from responses to the ICIq-OAB survey question on urgency (Q5a: 0 vs. ≥ 3). Real-time bladder sensation on a 0%-100% scale was recorded on a validated tablet sensation meter throughout two fill-void cycles. The first and second fills were considered "slow" and "fast" respectively. After each sensation meter change (sensation event), a pop-up screen asked participants to characterize sensation with one or more of these descriptors: "tense," "pressure," "tingling," "painful," and/or "other." Oral hydration was achieved by rapid consumption of 2L G2® Gatorade. Results: Data from 29 participants (12 normal/17 OAB) were analyzed. The rate of filling from bladder volume and fill duration, was greater for the fast fill in both groups. In the slow fill, "tingling" (64 ± 3% OAB vs. 77 ± 3% normal, p=0.008) and "tense" (78 ± 3% OAB vs. 94 ± 1% normal, p<0.001) occurred at lower sensations in OAB participants. Conclusion: During only the slow fill, OAB individuals experience the sensation descriptors of "tingling" and "tense" at earlier sensations than normal individuals. Therefore, this non-invasive method to evaluate real-time sensation descriptors during filling may identify important sensation patterns and improve understanding and phenotyping of OAB.
Preprint
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We present a novel methodology for subtyping of persons with a common clinical symptom complex by integrating heterogeneous continuous and categorical data. We illustrate it by clustering women with lower urinary tract symptoms (LUTS), who represent a heterogeneous cohort with overlapping symptoms and multifactorial etiology. Identifying subtypes within this group would potentially lead to better diagnosis and treatment decision-making. Data collected in the Symptoms of Lower Urinary Tract Dysfunction Research Network (LURN), a multi-center prospective observational cohort study, included self-reported urinary and non-urinary symptoms, bladder diaries, and physical examination data for 545 women. Heterogeneity in these multidimensional data required thorough and non-trivial preprocessing, including scaling by controls and weighting to mitigate data redundancy, while the various data types (continuous and categorical) required novel methodology using a weighted Tanimoto indices approach. Data domains only available on a subset of the cohort were integrated using a semi-supervised clustering approach. Novel contrast criterion for determination of the optimal number of clusters in consensus clustering was introduced and compared with existing criteria. Distinctiveness of the clusters was confirmed by using multiple criteria for cluster quality, and by testing for significantly different variables in pairwise comparisons of the clusters. Cluster dynamics were explored by analyzing longitudinal data at 3- and 12-month follow-up. Five distinct clusters of women with LUTS were identified using the developed methodology. The clinical relevance of the identified clusters is discussed and compared with the current conventional approaches to the evaluation of LUTS patients. Rationale and thought process are described for selection of procedures for data preprocessing, clustering, and cluster evaluation. Suggestions are provided for minimum reporting requirements in publications utilizing clustering methodology with multiple heterogeneous data domains.
Article
Pubococcygeal muscle injury can lead to stress urinary incontinence (SUI). M2 macrophages play a crucial role in myoblast differentiation during injured muscle regeneration. However, the underlying mechanism remains unclear. Recently, exosomes have attracted increasing attention due to their mediation of cell-to-cell communication. In this study, we found that M2 macrophages extensively infiltrated the pubococcygeal muscle on day 5 after injury (VD5) in vivo. Then, C2C12 myoblasts were treated with M2 macrophage-derived exosomes (M2-EXO) and the results revealed that these exosomes could promote myotube formation. MiR-501 was identified as one of the abundant microRNAs (miRNAs) selectively loaded in M2-EXO, and subsequently confirmed to promote C2C12 myoblast differentiation by targeting YY1. Moreover, in vivo experiments showed that M2-EXO improves the inflammatory cell infiltration and have a therapeutic effect on damaged pubococcygeal muscle in SUI models. Collectively, our present results provide new insights into the promyogenic mechanism of M2 macrophages and prove that M2 macrophage exosomal miR-501 may represent a potential therapeutic to promote recovery from diseases caused by muscle injury, including SUI.
Article
Objective: To assess whether more severe urinary symptoms and poorer quality of life among patients on diuretic therapy are associated with decreased adherence to the diuretic regimen. Methods: Participants were recruited via ResearchMatch.org and sent a REDCap survey. The Overactive Bladder Questionnaire-Short Form (OAB-q SF) was used to assess urinary symptom bother and health-related quality of life (HRQL). Participants were asked if they skip diuretic doses due to urinary symptoms with a bivariate (yes or no) outcome. Subgroup analyses of loop vs non-loop diuretic and those taking the diuretic for a cardiovascular indication (hypertension or heart failure) were performed. Results: A total of 4029 surveys were sent, 285 were returned (7.1% response rate), and 279 were included in the study. Fifty-three participants admitted to skipping diuretic doses due to urinary symptoms. Lower HRQL scores were significantly associated with poorer adherence scores among all participants (P < .001), among participants taking a loop diuretic (P < .001), and among participants with hypertension and heart failure (P < .039). Association between symptoms and adherence remained significant after adjustment in the multivariate model for the whole cohort and loop diuretic subgroup but lost significance in the hypertension and heart failure subgroup. Conclusions: Worsening quality of life due to urinary symptoms may be associated with poorer adherence to diuretics, particularly loop diuretics.
Article
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We measured patient reported bother due to overactive bladder syndrome, patterns of physician consultation and prescription medication use for overactive bladder symptoms in adults in the United States. A survey sample was derived from a consumer panel of 600,000 American households developed to match the United States Census of 260,000 adults. The survey included the Overactive Bladder-Validated 8 awareness tool, which includes 8 questions that measure the degree of bother due to specific bladder symptoms. A score of 8 or greater denotes probable overactive bladder. Additional questions probed treatment patterns, health care consultation, overactive bladder diagnosis, treatment type and prescription treatment used. A nonrespondent telephone survey in 1,004 participants was done to evaluate differences between mail survey respondents and nonrespondents. The response rate was 63% (162,906 respondents). Women represented 55.1% of the sample and 21.8% of respondents were 65 years old or older. Symptom bother, as determined by an Overactive Bladder-Validated 8 score of 8 or greater, was reported by 26.6% of the total sample, including 23.7% of men and 28.9% of women. The percent of men and women reporting bother increased with age. Of respondents with probable overactive bladder only 45.7% had discussed the symptoms with a medical provider, 22.5% had previously used prescription medication for overactive bladder, 13.5% had used overactive bladder medication in the last 12 months and 8.1% were currently on treatment. A substantial proportion of adults in the United States reported some degree of bother due to overactive bladder symptoms. The degree of bother was associated with age and gender. Overall less than half of patients with probable overactive bladder discussed the symptoms with a health care provider. A small proportion was prescribed medication and an even smaller proportion was currently on treatment.
Article
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Many costs are associated with overactive bladder (OAB). They include direct costs, such as those associated with treatment, diagnosis, routine care, and the consequences of the disease; indirect costs of lost wages and productivity; and intangible costs associated with pain, suffering, and decreased quality of life. Quantification of all these costs is essential for establishing the total economic burden of a disease on society. Currently, the total economic burden of OAB is unknown. However, various studies have determined that the economic burden of urinary incontinence, one of the symptoms of OAB, is substantial. It is also important to establish the economic impact of various interventions for OAB. Cost-minimization, cost-outcome, cost-utility, and cost-benefit models can be used for these analyses. The most difficult aspect of evaluating the economic impact of a treatment is estimating the intangible costs.
Article
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To estimate the prevalence of and risk factors for stress and urge incontinence in a biracial sample of well-functioning older women. We performed a cross-sectional analysis of 1,584 white and black women, aged 70-79 years, enrolled in a longitudinal cohort study. Participants were asked about incontinence, medical problems, and demographic and reproductive characteristics and underwent physical measurements. Using multivariable logistic regression, we compared women reporting at least weekly incontinence with those without incontinence. Overall, 21% reported incontinence at least weekly. Of these, 42% reported predominantly urge incontinence, and 40% reported stress. Nearly twice as many white women as black women reported weekly incontinence (27% versus 14%, P <.001). Factors associated with urge incontinence included white race (odds ratio [OR] 3.1, 95% confidence interval [CI] 2.0-4.8), diabetes treated with insulin (OR 3.5, 95% CI 1.6-7.9), depressive symptoms (OR 2.7, 95% CI 1.4-5.3), current oral estrogen use (OR 1.7, 95% CI 1.1-2.6), arthritis (OR 1.7, 95% CI 1.1-2.6), and decreased physical performance (OR 1.6 per point on 0-4 scale, 95% CI 1.1-2.3). Factors associated with stress incontinence were chronic obstructive pulmonary disease (OR 5.6, 95% CI 1.3-23.2), white race (OR 4.1, 95% CI 2.5-6.7), current oral estrogen use (OR 2.0, 95% CI 1.3-3.1), arthritis (OR 1.6, 95% CI 1.0-2.4), and high body mass index (OR 1.3 per 5 kg/m2, 95% CI 1.1-1.6). Urinary incontinence is highly prevalent, even in well-functioning older women, whites in particular. Many risk factors differ for stress and urge incontinence, suggesting differing etiologies and prevention strategies.
Article
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Overactive bladder (OAB) may affect health-related quality of life. Few data have been gathered on the impact of OAB or on patient satisfaction with therapy. This 2002 survey examined the effects of OAB on participants; treatment-seeking behaviors, patient satisfaction with oral OAB therapies, and desirable characteristics of new treatments were investigated. An online questionnaire was administered to 1228 women aged 40-65 years with at least a high school education and minimum annual income of 35,000 dollars. Respondents were categorized as having no OAB symptoms (control group; n = 330) or as having OAB symptoms (n = 898). Those with symptoms were subdivided into treatment groups: current users of prescription OAB medications (n = 309), lapsed prescription medication users (n = 265), and those never treated (n = 324). The significance of between-group differences in response was assessed through 95% confidence levels. Symptoms of OAB significantly affect self-esteem, family relations, sexual relations, lifestyle, professional life, and health perception. More than half of women who discussed OAB with a health care provider (56%) waited longer than 1 year to seek treatment; many attempted to self-manage symptoms. Health care providers rarely screen for OAB, leaving many conditions undiagnosed and patients untreated. Women treated for OAB expressed significant dissatisfaction with current OAB therapies and the desire for more effective, convenient treatments with fewer adverse effects. Likely outcomes should be discussed with patients before treatment is initiated so that expectations are realistic and patients' overall satisfaction with treatment is enhanced.
Article
This descriptive, cross-sectional survey examined the impact of overactive bladder (OAB) on health care resource utilization, daily activities, work productivity, and health complications. Also studied was the extent to which patients perceived treatment to be successful. Health care resource utilization was high among the 441 respondents, of whom more than 20% reported daily activity impairment, reduced productivity, or a high incidence of urinary tract infection. Successful management of OAB with prescription drugs, when compared with unsuccessful management, was associated with reduced impairment of daily activities and work productivity, lower health care resource consumption, and fewer complications. Providing effective prescription drug treatment and enhancing patients' perception of treatment success may help alleviate the clinical and economic impact of OAB.
Article
最近わが国でも尿失禁が重要な疾患として認識されつつある. 尿失禁の治療は理学療法や手術療法もあるが, その中心は薬物療法である. この薬物療法の一つにエストロゲンがあげられているが, その効果については必ずしも評価が定まっていない. 基礎実験のデータでも, 臨床研究でもエストロゲンが効果ありとする説と否定的な説が相半ばしている. しかし更年期以降の尿失禁の患者に一定期間エストロゲンを投与すると尿道閉鎖圧, および腹圧の尿道へのtransmissionが改善し, 全例ではないとしても尿失禁が治癒するか改善する症例があることは確かである. しかし無効な例も少なからず認められることから, エストロゲンを更年期以降の尿失禁治療のファーストチョイスの薬剤には使用しにくい. 他にエストロゲン投与の適応があったり, 他の尿失禁治療の補助としての使用が最も妥当なものであろう. ただしエストロゲンには血栓や発癌性などの問題があり, 使用にあたっては十分な注意が必要である.
Article
Differences in health burden associated with urinary incontinence (UI) subtypes have been previously described, but the majority of studies are in women. Additional research is needed to examine the prevalence and burden of UI subtype including postmicturition incontinence, nocturnal enuresis, coital incontinence, and incontinence for unspecified reasons. Examine the burden of UI in men and women in Sweden, the United Kingdom, and the United States. Secondary analyses of the Epidemiology of Lower Urinary Tract Symptoms (EpiLUTS), a cross-sectional Internet survey, were performed. Participants who reported UI were categorized as (1) urgency urinary incontinence (UUI) only, (2) stress urinary incontinence (SUI) only, (3) mixed urinary incontinence (MUI), (4) UUI plus other incontinence (OI), (5) SUI plus OI, or (6) OI. Differences in health outcomes across UI groups were explored by gender using descriptive statistics and general linear models. Outcomes included treatment seeking for urinary symptoms, perception of bladder condition, depression, anxiety, and health-related quality of life (HRQL). Of 14 140 men and 15 860 women, 6479 men (45.8%) and 10 717 women (67.6%) reported UI. The most prevalent UI subgroups were OI in men and SUI in women. MUI and SUI plus OI had the greatest treatment seeking among men, whereas MUI and UUI plus OI had the greatest treatment seeking among women. Men with MUI had the highest rates of anxiety, followed by those with UUI plus OI and SUI plus OI, and OI with a similar trend observed for depression. Anxiety and depression were highest in SUI plus OI and MUI women. MUI and UUI plus OI men and women had significantly lower HRQL compared with other UI groups. UI is common in men and women aged >40. Individuals with UUI combined with SUI or OI bear a greater mental health burden and report poorer HRQL.
Article
We examined the relationship between self-reported health status data, subsequent antimuscarinic medication adherence and health care service use in older adults with OAB syndrome in a managed care setting. This was a longitudinal cohort study of older adults in the southeastern United States with OAB who completed a health status assessment, used antimuscarinic medications and were enrolled in an HMO continuously for 1 to 3 years. Demographic, clinical and use related economic variables were also retrieved from the administrative claims data of patient HMOs. Prescription refill patterns were used to measure medication adherence. Associations were examined with a sequential, mixed model regression approach. A total of 275 patients were included. The severity of comorbidity (Charlson index), patient perception of quality of life (Short Form-12 scores) and total number of prescribed medications during the year prior to enrollment in a Medicare HMO were independently associated with decreased antimuscarinic MPRs after enrollment. After controlling for other variables increased antimuscarinic MPR remained the strongest predictor of decreased total annual health care costs (5.6% decrease in annual costs with every 10% increase in MPR, p < 0.001). We found strong associations between decreased antimuscarinic medication adherence and increased health care service use in older adults with OAB in a managed care setting. Health status assessments completed at enrollment had the potential to identify enrollees at higher risk for nonadherent behaviors and poor health related outcomes.
Article
To estimate the prevalence of and bother associated with overactive bladder (OAB) in adults aged ≥40 years in the United States, using current International Continence Society definitions. Internet-based panel members were selected randomly to participate in EpiLUTS, a cross-sectional, population-representative survey. Participants used Likert scales to rate how often they experienced individual lower urinary tract symptoms during the previous 4 weeks and how much bother they experienced. Based on responses to questions regarding urgency and urgency urinary incontinence, OAB symptoms were categorized as occurring at least "sometimes" or at least "often." Symptom bother was categorized as at least "somewhat" or at least "quite a bit." The response rate was 59.6%, with a final sample of 9416 men and 10,584 women. Prevalence of OAB symptoms at least "sometimes" was 27.2% and 43.1% for men and women, respectively; prevalence of OAB at least "often" was 15.8% and 32.6%, respectively. Among men with OAB symptoms at least "sometimes," 60.0% were bothered at least "somewhat" and 27.8% were bothered at least "quite a bit." Among women, bother rates were 67.6% and 38.9%, respectively. Among respondents with OAB at least "often," 67.8% and 38.2% of men and 73.0% and 47.1% of women reported being bothered at least "somewhat" and at least "quite a bit," respectively. We estimate that 29.8 million adults aged ≥40 years in the United States have bothersome OAB symptoms. Bothersome OAB symptoms are highly prevalent among men and women aged ≥40 years in the United States.
Article
• To estimate and predict worldwide and regional prevalence of lower urinary tract symptoms (LUTS), overactive bladder (OAB), urinary incontinence (UI) and LUTS suggestive of bladder outlet obstruction (LUTS/BOO) in 2008, 2013 and 2018 based on current International Continence Society symptom definitions in adults aged ≥20 years. • Numbers and prevalence of individuals affected by each condition were calculated with an estimation model using gender- and age-stratified prevalence data from the EPIC study along with gender- and age-stratified worldwide and regional population estimates from the US Census Bureau International Data Base. • An estimated 45.2%, 10.7%, 8.2% and 21.5% of the 2008 worldwide population (4.3 billion) was affected by at least one LUTS, OAB, UI and LUTS/BOO, respectively. By 2018, an estimated 2.3 billion individuals will be affected by at least one LUTS (18.4% increase), 546 million by OAB (20.1%), 423 million by UI (21.6%) and 1.1 billion by LUTS/BOO (18.5%). • The regional burden of these conditions is estimated to be greatest in Asia, with numbers of affected individuals expected to increase most in the developing regions of Africa (30.1-31.1% increase across conditions, 2008-2018), South America (20.5-24.7%) and Asia (19.7-24.4%). • This model suggests that LUTS, OAB, UI and LUTS/BOO are highly prevalent conditions worldwide. Numbers of affected individuals are projected to increase with time, with the greatest increase in burden anticipated in developing regions. • There are important worldwide public-health and clinical management implications to be considered over the next decade to effectively prevent and manage these conditions.
Article
To calculate, from a societal perspective, current direct (medical and nonmedical) and indirect costs of overactive bladder (OAB) in the United States and project them to future years. Existing cost assessments of OAB in the United States are incomplete and outdated. A prevalence-based model was developed incorporating age- and sex-specific OAB prevalence rates, usage data, and productivity data. On the basis of the information gathered from the recent 5 years of the medical literature, practice guidelines, Medicare and managed care fee schedules, and expert panel input, the annual per capita and total US costs were calculated for 2007. US census population forecasts were used to project the costs of OAB to 2015 and 2020. In 2007, average annual per capita costs of OAB were $1925 ($1433 in direct medical, $66 in direct nonmedical, and $426 in indirect costs). Applying these costs to the 34 million people in the United States with OAB results in total national costs of $65.9 billion (billion = 1000 million), ($49.1 billion direct medical, $2.3 billion direct nonmedical, and $14.6 billion indirect). Average annual per capita costs in 2015 and 2020 would be $1944 and $1969 and total national costs would be $76.2 billion and $82.6 billion, respectively. These data suggest that the economic burden of OAB is about 5-fold higher than older, noncomprehensive estimates. These costs are higher than previously published data for the United States and Europe because this analysis relies on more current data, real world age- and sex-specific treatment patterns and costs, and includes a more complete set of cost components.
Article
Next to existing terminology of the lower urinary tract, due to its increasing complexity, the terminology for pelvic floor dysfunction in women may be better updated by a female-specific approach and clinically based consensus report. This report combines the input of members of the Standardization and Terminology Committees of two international organizations, the International Urogynecological Association (IUGA), and the International Continence Society (ICS), assisted at intervals by many external referees. Appropriate core clinical categories and a subclassification were developed to give an alphanumeric coding to each definition. An extensive process of 15 rounds of internal and external review was developed to exhaustively examine each definition, with decision-making by collective opinion (consensus). A terminology report for female pelvic floor dysfunction, encompassing over 250 separate definitions, has been developed. It is clinically based with the six most common diagnoses defined. Clarity and user-friendliness have been key aims to make it interpretable by practitioners and trainees in all the different specialty groups involved in female pelvic floor dysfunction. Female-specific imaging (ultrasound, radiology, and MRI) has been a major addition while appropriate figures have been included to supplement and help clarify the text. Ongoing review is not only anticipated but will be required to keep the document updated and as widely acceptable as possible. A consensus-based terminology report for female pelvic floor dysfunction has been produced aimed at being a significant aid to clinical practice and a stimulus for research.
Article
To evaluate adherence with overactive bladder (OAB) pharmacotherapy and compare costs between patients receiving pharmacotherapy versus nonpharmacologic management. Retrospective cohort study using anonymous, patient-level data from administrative claims from the PharMetrics database. Patients 18 years of age or older who received an OAB diagnosis or OAB medication prescription from January 1, 2005, through December 31, 2006, were identified. Eligible patients had continuous health plan enrollment from 6 months before to 12 months after the index date (date of first OAB prescription or first OAB diagnosis); exclusion criteria included prior OAB therapy use. Study cohorts were stratified as OAB therapy or nonpharmacologically managed based on evidence of treatment and matched using propensity score methodology. Outcomes included adherence rates with OAB therapy (defined as proportion of days covered [PDC]) and comparative costs of OAB pharmacotherapy versus nonpharmacologic management from a healthcare payer perspective. Adherence among OAB therapy patients was low, with 14% of patients achieving PDC of 80% or higher and an average PDC of 32%. Unadjusted total costs were approximately 3% higher for OAB therapy versus nonpharmacologically managed patients due to higher pharmacy costs. Conversely, outpatient service and inpatient hospitalization costs were higher for nonpharmacologically managed patients. Results did not change after adjusting for patient characteristics. Results confirm low adherence to OAB pharmacotherapy, with few patients achieving PDC of 80% or higher. Total costs were higher among OAB therapy patients due to higher pharmacy costs, but outpatient and inpatient costs were higher among nonpharmacologically managed patients. Additional research into optimizing pharmacotherapeutic regimens may provide insight into improving treatment adherence.
Article
To determine the prevalence, incidence, and remission rates of urinary incontinence in a large group of older women over a 6-year time span and to assess factors associated with incontinence incidence and remission. Longitudinal cohort study. Two rural counties in Iowa. 2025 women aged 65 years or older residing in rural Iowa, enrolled in the Iowa 65+ Rural Health Study of EPESE (Establishment of Populations for Epidemiologic Studies of the Elderly) were interviewed in person annually for 6 years; specific responses to queries about urinary incontinence were given at baseline, 3-, and 6-year intervals. Conditional multivariate logistic regression analysis was done to assess the relationship between incontinence symptoms and various factors previously found to be related to incontinence. The baseline prevalence of urge incontinence was 36.3%, and of stress incontinence it was 40.3%. For urge incontinence, the 3-year incidence and remission rates between the third and sixth years were 28.5% and 22.1%, respectively. For stress incontinence, the 3-year incidence and remission rates between years 3 and 6 were 28.6% and 25.1%, respectively. Seventy-six percent and 84% of women who reported no urge or stress incontinence, respectively, at the baseline interview were continent at both follow-up interviews. The only significant factors related to changes in incontinence status were age, which was associated with an increased incidence of urge incontinence (OR 1.11, P = .017, 95% CI 1.019-1.203), and improvement in activities of daily living, which was associated with a increased remission of urge incontinence (OR 0.50, P = .015, 95% CI 0.28-0.9) In some older women, urinary incontinence is a dynamic state, with women moving back and forth along a continuum between continence and incontinence. These results are tempered by limitations of the study, which include its questionnaire design and lack of ability to detect potential treatment effect.
Article
Prevalence estimates for urinary incontinence among community-dwelling adults vary from 2 to 55%. A review of the literature was undertaken to investigate the degree to which differences in definitions of incontinence, age, and gender of the populations studied, response rates, measurement techniques, or location could explain differences in reported prevalences. A literature search was conducted to locate all studies published in English reporting the prevalence of urinary incontinence in a population-based sample of adults. Information was abstracted for study size, response rate, type of survey, definition of urinary incontinence, and prevalence of incontinence by age group and gender. Prevalence by type of incontinence was also abstracted where available. Stratification was used to obtain prevalence estimates specific for age, gender, and frequency of incontinence. Data were examined for associations between prevalence and survey type, response rate, year, and location of survey. A total of 21 studies met inclusion criteria. Stratification of reported prevalence by frequency, gender, and age substantially reduced the variation in prevalence estimates. For older women, the estimated prevalence of urinary incontinence ranged from 17 to 55% (median = 35%, pooled mean = 34%), and for daily incontinence it ranged from 3 to 17% (median = 14%, pooled mean = 12%). For older men, incontinence prevalence was estimated to be 11 to 34% (median = 17%, pooled mean = 22%), and 2 to 11% reported daily incontinence (median = 4%, pooled mean = 5%). Within studies, the prevalence of any incontinence was 1.3 to 2.0 times greater for older women than for older men. Among middle-aged and younger adults, prevalence of incontinence ranged from 12 to 42% (median = 28%, pooled mean = 25%) for women and from 3 to 5% (median = 4%, pooled mean = 5%) for men. The ratio of prevalence of any incontinence for women to men in this age group ranged from 4.1 to 4.5. Stress incontinence predominated in younger women, whereas urge and mixed incontinence predominated in older women. There was a tendency for studies using in-person interviews to report higher prevalences. An accurate estimate of the prevalence of urinary incontinence depends on specifying the definition of incontinence and the age and gender groups of interest.
Article
Previous studies have demonstrated the effect of incontinence, and urge incontinence in particular, on patients' quality of life. This study assessed the effects of urge incontinence on quality of life and measured the value of a reduction in symptoms. A self-administered questionnaire was mailed to 591 patients with urge or mixed incontinence. 495 (83.8%) surveys were returned with complete quality of life and symptom data. Of the total sample, 411 patients received the willingness-to-pay (WTP) survey, from which 257 (62.53%) returns were judged complete and reliable. Information was collected about the number of micturitions and urinary leakages. Health-related quality of life (HR-QOL) was measured using the Short Form 36 (SF-36) Health Survey. Socioeconomic characteristics were also recorded. Value was assessed with a binary WTP question. Quality of life among the sample population was significantly lower in 5 of 8 dimensions compared with the general US population, and was significantly related to the severity of the symptoms in 6 of 8 dimensions. The median (mean) willingness to pay was $US27.24 ($US87.74) per month for a 25% reduction in micturitions and leakages, and $US75.92 ($US244.54) per month for a 50% reduction in micturitions and leakages. As expected, the willingness to pay was significantly related to the size of the reduction in micturitions and leakages, and household income. Patients with incontinence perceive substantial benefits from a reduction in the number of micturitions and leakages.
Article
To determine if urge urinary incontinence is associated with risk of falls and non-spine fractures in older women. Type and frequency of incontinent episodes were assessed by 6,049 community-dwelling women using a self-completed questionnaire. Postcards were subsequently mailed every 4 months to inquire about falls and fractures. Incident fractures were confirmed by radiographic report. Logistic and proportional hazard models were used to assess the independent association of urge urinary incontinence and risk of falling or fracture. The mean age of the women was 78.5 (+/- 4.6) years. During an average follow-up of 3 years, 55% of women reported falling, and 8.5% reported fractures. One-quarter of the women (1,493) reported weekly or more frequent urge incontinence, 19% (1,137) reported weekly or more frequent stress incontinence, and 708 (12%) reported both types of incontinence. In multivariate models, weekly or more frequent urge incontinence was associated independently with risk of falling (odds ratio = 1.26; 95% confidence interval (CI), 1.14-1.40) and with non-spine nontraumatic fracture (relative hazard 1.34; 95% CI, 1.06-1.69; P = .02). Stress incontinence was not associated independently with falls or fracture. Weekly or more frequent urge incontinence was associated independently with an increased risk of falls and non-spine, nontraumatic fractures in older women. Urinary frequency, nocturia, and rushing to the bathroom to avoid urge incontinent episodes most likely increase the risk of falling, which then results in fractures. Early diagnosis and appropriate treatment of urge incontinence may decrease the risk of fracture.
Article
To estimate the annual direct cost of urinary incontinence in 1995 US dollars. Epidemiologically based models using diagnostic and treatment algorithms from published clinical practice guidelines and current disease prevalence data were used to estimate direct costs of urinary incontinence. Prevalence and event probability estimates were obtained from literature sources, national data sets, small surveys, and expert opinion. Average national Medicare reimbursement was used to estimate costs, which were determined separately by gender, age group, and type of incontinence. Sensitivity analyses were performed on all variables. The annual direct cost of urinary incontinence in the United States (in 1995 dollars) was estimated as $16.3 billion, including $12.4 billion (76%) for women and $3.8 billion (24%) for men. Costs for community-dwelling women ($8.6 billion, 69% of costs for women) were greater than for institutionalized women ($3.8 billion, 31%). Costs for women over 65 years of age were more than twice the costs for those under 65 years ($7.6 and $3.6 billion, respectively). The largest cost category was routine care (70% of costs for women), followed by nursing home admissions (14%), treatment (9%), complications (6%), and diagnosis and evaluations (1%). Costs were most sensitive to changes in incontinence prevalence, routine care costs, and institutionalization rates and costs. Urinary incontinence is a very costly condition, with annual expenditures similar to other chronic diseases in women.
Article
To compare the prevalence of urinary incontinence symptoms among black, white, and Hispanic women. Women attending our gynecologic clinic were asked to complete a survey. The survey asked: "Do you lose urine when you cough, sneeze, lift, jump, or get up from a bed or chair? Do you wear a pad or protective undergarment because you lose urine when you cough, sneeze, lift, jump, or get up from a bed or chair? Do you urinate more than once every hour during the day? Does the urge to urinate wake you from your sleep more than twice most nights? Do you lose urine less than 5 minutes after you feel the urge to urinate more than once per week? Seven hundred ninety-nine black, 932 white, and 639 Hispanic women completed the survey. More white women reported urinary incontinence than did black or Hispanic women (41% versus 31% versus 30%, P <.001) because of their higher prevalence of stress incontinence symptoms (39% versus 27% versus 24%, P <.001). The percentage of women who had urge incontinence symptoms was very similar between the three groups (19% versus 16% versus 16%, P =.214). More black and white women reported mixed incontinence than Hispanic women (14% versus 15% versus 9%, P <.001). More black women had frequency and nocturia than the other two groups (31% and 35% versus 19% and 19% versus 25% and 26%, P <.001). The prevalence of incontinence symptoms is significantly different among black, Hispanic, and white women.
Article
To estimate the economic costs of overactive bladder (OAB), including community and nursing home residents, and to compare the costs in male versus female and older versus younger populations. The National Overactive Bladder Evaluation Program included a representative telephone survey of 5204 community-dwelling adults 18 years and older in the United States and a follow-up postal survey of all individuals with OAB identified and age and sex-matched controls. The postal survey asked respondents about bladder symptoms, self-care use, treatment use, work loss, and OAB-related health consequences. Survey data estimates were combined with year 2000 average cost data to calculate the cost of OAB in the community. Institutional costs were estimated from the costs of urinary incontinence in nursing homes, limited to only those with urge incontinence or mixed incontinence (urge and stress). The estimated total economic cost of OAB was 12.02 billion dollars in 2000, with 9.17 and 2.85 billion dollars incurred in the community and institutions, respectively. Community female and male OAB costs totaled 7.37 and 1.79 billion dollars, respectively. The estimated total cost was sensitive to the estimated prevalence of OAB; therefore, we calculated the average cost per community-dwelling person with OAB, which was 267 dollars per year. By quantifying the total economic costs of OAB, this study-the first obtained from national survey data-provides an important perspective of this condition in society. The conservative estimates of the total cost of OAB were comparable to those of osteoporosis and gynecologic and breast cancer. Although this provides information on the direct and indirect costs of OAB, quality-of-life issues must be taken into account to gain a better understanding of this condition.
Article
To measure prevalence and characteristics of urinary incontinence in older Mexican-American women. Cross-sectional analysis of a longitudinal survey of a representative sample of older Mexican Americans. Five southwestern states in the United States. A total of 1589 Mexican-American women, aged 65 and older who were part of the Hispanic Established Population for the Epidemiologic Study of the Elderly. Self-reported psychosocial, demographic, and health variables; self-reported history of symptoms of urinary incontinence. Two hundred thirty-nine (15%) of the 1589 Mexican-American women reported having urinary incontinence. Almost 33% reported urge incontinence symptoms, 10% reported stress incontinence symptoms, and 42% had symptoms suggestive of mixed incontinence. Thirty-five percent of subjects reported incontinence episodes with moderate to large amounts of urine loss, and 15% reported that their urinary symptoms kept them from engaging in social activities. Age and body mass index were risk factors for incontinence (P=.02 and P=.03, respectively). This is the first community-based survey examining rates of urinary incontinence in Mexican-American women. The prevalence of urinary incontinence may be lower in older Mexican-American women than in the general population. They may also have a higher percentage of urge as opposed to stress incontinence symptoms and may suffer from moderate to large volumes of urine loss associated with their incontinence episodes.
Article
To update the cost of urinary incontinence (UI) for year 2000 and compare it with the cost of overactive bladder (OAB). Using the cost-of-illness framework, disease epidemiologic data were combined with treatment rates, consequence probabilities, and average cost estimates. All costs reflect the costs during 2000. The total cost of UI and OAB was 19.5 billion dollars and 12.6 billion dollars, respectively (year 2000 dollars). With UI, 14.2 billion dollars was borne by community residents and 5.3 billion dollars by institutional residents. With OAB, 9.1 and 3.5 billion dollars, respectively, was incurred by community and institutional residents. OAB affected 34 million individuals compared with 17 million with UI. Despite the differences in epidemiology, the total and per-person costs of UI were higher than the OAB costs because OAB individuals without incontinent episodes incurred fewer costs, on average.
Article
We compared the prevalence of urinary incontinence by type among white, black, Hispanic and Asian-American women. The RRISK is a population based cohort study of 2,109 randomly selected middle-aged and older women. Incontinence and other variables were assessed by self-report questionnaires and in person interviews. Labor and delivery and surgical data were abstracted from medical records archived since 1946. Logistic regression was used to estimate the OR with 95% CIs for incontinence while adjusting for covariates. The age adjusted prevalence of weekly incontinence was highest among Hispanic women, followed by white, black and Asian-American women (36%, 30%, 25% and 19%, respectively, p <0.001). Type of incontinence also differed among groups, with weekly stress incontinence prevalence being 18%, 15%, 8% and 8% (p <0.001), and weekly urge incontinence prevalence being 10%, 9%, 14% and 7% (p <0.001). After adjustment for age, parity, hysterectomy, estrogen use, body mass, menopausal status and diabetes, the risk of stress incontinence remained significantly lower in black (adjusted OR 0.36, 95% CI 0.23-0.57) and Asian-American (adjusted OR 0.54, 95% CI 0.34-0.86) women compared to white women. In contrast, the risk of urge incontinence was similar in black (adjusted OR 1.19, 95% CI 0.79-1.81) and Asian-American (adjusted OR 0.86, 95% CI 0.52-1.43) women compared to white women. Significant differences in the adjusted risk of stress incontinence among Hispanic, white, black and Asian-American women suggest the presence of additional, as yet unrecognized, risk or protective factors for stress incontinence.
Article
To estimate costs of routine care for female urinary incontinence, health-related quality of life, and willingness to pay for incontinence improvement. In a cross-sectional study at 5 U.S. sites, 293 incontinent women quantified supplies, laundry, and dry cleaning specifically for incontinence. Costs were calculated by multiplying resources used by national resource costs and presented in 2005 United States dollars (2005). Health-related quality of life was estimated with the Health Utilities Index. Participants estimated willingness to pay for 25-100% improvement in incontinence. Potential predictors of these outcomes were examined using multivariable linear regression. Mean age was 56 +/- 11 years; participants were racially diverse and had a broad range of incontinence severity. Nearly 90% reported incontinence-related costs. Median weekly cost (25%, 75% interquartile range) increased from 0.37 dollars (0, 4 dollars) for slight to 10.98 dollars (4, 21 dollars) for very severe incontinence. Costs increased with incontinence severity (P < .001). Costs were 2.4-fold higher for African American compared with white women (P < .001) and 65% higher for women with urge compared with those having stress incontinence (P < .001). More frequent incontinence was associated with lower Health Utilities Index score (mean 0.90 +/- 0.11 for weekly and 0.81 +/- 0.21 for daily incontinence; P = .02). Women were willing to pay a mean of 70 dollars +/- 64 dollars per month for complete resolution of incontinence, and willingness to pay increased with income and greater expected benefit. Women with severe urinary incontinence pay 900 dollars annually for incontinence routine care, and incontinence is associated with a significant decrement in health-related quality of life. Effective incontinence treatment may decrease costs and improve quality of life. III.
Article
To estimate and compare the current and future direct cost of overactive bladder (OAB) to the health care systems of five European countries. A health economic model was created to estimate the number of people currently affected by OAB symptoms, the expected number to be affected in the future, and the resultant economic burden on health care systems in Germany, Italy, Spain, Sweden, and the United Kingdom. The model estimated that in 2000, 20.2 million people over age 40 in the five countries experienced the symptoms of OAB; 7 million of these had urgency with urge incontinence. This figure is expected to rise to 25.5 million by 2020, including 9 million who will have urgency with urge incontinence. Average annual direct costs of OAB management ranged from euro269 to euro706 per patient per year. The largest cost was the use of incontinence pads, accounting for an average of 63% of the annual per patient cost of OAB management. Total cost to health care systems across all five countries was estimated at euro4.2 billion in 2000, and by 2020, the expected total cost was estimated to be euro5.2 billion, an increase of euro1 billion (26%). OAB is prevalent, with a substantial direct cost that is anticipated to increase in the future in line with aging populations. The overall burden, including indirect costs, may be considerably larger, and will fall predominantly on the elderly OAB population with urge incontinence. Recommended medical treatments could help manage those costs and should be evaluated.
Article
To examine the impact of each type of urinary incontinence (stress, urge, and mixed) on health-related quality of life (HRQL). The USA National Overactive Bladder Evaluation (NOBLE) programme of prevalence was used to identify respondents with incontinence based upon telephone survey responses. A nested case-control study was then conducted on respondents with symptoms of an overactive bladder (OAB), and on age and gender-matched controls; this consisted of the respondents completing a series of questionnaires, including the OAB-q (an HRQL scale for OAB), the Medical Outcomes Study (MOS) Short-Form-36 (SF-36), the MOS Sleep Scale, and the Center for Epidemiological Studies - Depression (CES-D) scale. Respondents were categorized into subgroups according to the primary cause of urine loss, i.e. sudden/uncomfortable urge to urinate (urge, UI), physical pressure (stress, SI), or both (mixed, MI). Descriptive analyses, t-tests and analysis of variance with post hoc comparisons were used. Of the 919 participants in the nested case-control study, 171 reported incontinence, i.e. UI (69), SI (62) and MI (40). Among this cohort, 82.5% were female, 85.4% were Caucasian and the population had a mean age of 55.9 years. All OAB-q subscale scores were significantly (P < 0.01) worse among those with MI than with SI. Respondents with UI reported significantly higher levels of symptom bother and lower sleep scores (both P < 0.001) than those with SI. There were no differences in HRQL between the MI and UI groups. Voiding frequency and nocturia episodes did not differ among the groups but compared with the SI group, both UI and MI groups reported significantly higher ratings of urinary urge intensity (P < 0.001) and rated their need for medical care significantly higher (P < 0.01). The MI group reported more incontinence episodes (P = 0.02) than the SI group. Compared with SI, respondents with UI and MI reported not only significantly greater ratings of urinary urge intensity and more incontinence episodes, but also significantly worse HRQL. These results are consistent with previous findings which indicated a greater impact on HRQL for the urge component of MI than for the stress component.
Article
Epidemiological studies on urinary incontinence (UI) in adult men of all ages are scarce. We aim to describe the UI phenomenon among community dwelling adult males in the United States (US). We analyzed data from male respondents to a 14-item mailed UI symptoms questionnaire to the National Family Opinion (NFO) World Group Panel of 45,000 households matching the US 2000 census population on five key demographic elements. A total of 29,903 households responded, of which 21,590 were male heads of household (mean age 50 +/-15.2 years old). A total of 2,059 men (12.7%) reported symptoms of UI during the last 30 days. Symptoms of urge urinary incontinence (UUI), stress urinary incontinence (SUI), mixed urinary incontinence (MUI) symptoms, and other types of urinary incontinence (OUI) symptoms, were reported by 44.6%, 24.5%, 18.8%, and 12.3%, respectively. Among those with UI symptoms, the proportion of UUI and MUI symptoms increases with age while SUI symptoms decrease as age increases. Of those with UI symptoms, 44% consulted a physician of whom 57% did so within 6 months of the onset of symptoms. Treatments reported included absorbent pads (48%), prescription medication (30%), surgical procedure (18%), and intermittent catheterization (4%). Almost 1 in 10 males reported symptoms of UI. The UI prevalence rate increases with age and UUI symptoms is the most prevalent type reported. Less than half of men with UI symptoms sought professional help and half of them did so within 6 months of onset of UI symptoms.
Article
The purpose of this study was to estimate the direct costs of routine care for urinary incontinence (UI) in community-dwelling, racially diverse women. In the Reproductive Risks for Incontinence Study at Kaiser population-based study, 528 women with UI weekly or more quantified resources that were used for UI. Routine care costs were calculated with the use of national resource costs ($2005). Potential predictors of these outcomes were examined by multivariable linear regression. Mean age was 55 +/- 9 (SD) years. Among women with weekly UI, 69% reported incontinence-related costs. Median weekly cost was $1.83 (25%-75% interquartile range [IQR], $0.50, $5.23), increasing from $0.93 (IQR, $0, $3) for moderate to $7.82 (IQR, $5, $37) for very severe incontinence. Costs that increased with incontinence severity (P < .001) and body mass index (P < .001) were 2.2-fold higher for African American versus white women (P < .0001) and 42% higher for women with mixed versus stress incontinence (P < .05). Women pay a mean of >$250 per year out-of-pocket for UI routine care. Effective incontinence treatment may decrease costs.
Article
We determined racial differences in urinary incontinence prevalence using the 2001-2004 National Health and Nutrition Examination Survey. The National Health and Nutrition Examination Survey is a continuous survey of a representative sample of the noninstitutionalized United States population. Demographic, self-reported racial/ethnic data and responses to the urinary portion of the survey were available for 4,229 women older than 20 years. We classified women by urinary incontinence subtype, that is pure stress incontinence, pure urge incontinence or mixed incontinence. Logistic regression models were fitted to investigate racial differences by type of urinary incontinence. The sample was racially and ethnically diverse with 58% white nonHispanic, 22% Mexican-American and 20% black nonHispanic. Women were divided into 3 age ranges of 20 to 39 years old (36.3%), 40 to 59 (28%), and 60 years old or older (35.7%). Of the 4,229 women in the analytical sample 49.6% (2,098) reported urinary incontinence symptoms. Of those reporting incontinence symptoms 49.8% reported pure stress incontinence, 34.3% mixed incontinence and 15.9% pure urge incontinence. The odds of pure stress incontinence in white and Mexican-American women were approximately 2.5 times higher than in black women (OR 2.79, CI 2.1-3.8 and OR 2.5, CI 1.9-3.4) after adjusting for age, parity, body mass index and activity level. In contrast, black and Mexican-American women were more likely to report pure urge incontinence compared to white women (OR 0.6, CI 0.43-0.8). The prevalence of mixed incontinence was not significantly different among race/ethnicity groups. Race/ethnicity differences exist in self-reported urinary incontinence. While self-reported urinary incontinence is prevalent in United States community dwelling women regardless of racial background, the odds of pure stress incontinence are at least 2.5-fold higher in white and Mexican-American women than in black women.
Article
To estimate symptom bother and health care seeking among individuals with overactive bladder (OAB; ie, cases) using current International Continence Society definitions. This was a nested case-controlled analysis of data from the EPIC study, a population-based, cross-sectional survey of adults in five countries. Cases and matched controls were asked about risk factors, use of coping techniques, and health care seeking for urinary symptoms. Cases were asked about symptom bother and assessed with the Overactive Bladder-Validated 8 and Patient Perception of Bladder Condition instruments. Among cases (n=1434), 54% reported symptom bother; rates were similar between men (54%) and women (53%). Significantly more men with urinary incontinence (UI) reported bother (77%) than women with UI (67%; p<or=0.05). Among cases with UI who reported bother, more women (73%) than men (51%) used a urinary symptom coping technique, and the proportions were significantly greater than controls (men: 10%; women: 15%; p<or=0.05 for cases with UI vs. controls). Among cases using coping techniques, 63% of men and 69% of women initiated a conversation with a health care provider. Initiation of conversation with a health care provider was highest among cases who had a doctor visit within 6 mo (odds ratio [OR], 2.8), used coping techniques (OR, 2.2), or reported symptom bother (OR, 2.2). Cases reporting symptom bother, particularly those with UI, were significantly more likely to use coping techniques and seek health care advice. Clinicians should screen for OAB in all cases and assess symptom bother in those affected to guide diagnosis and treatment.