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The article discusses the results of a study that examines the predictors of success and satisfaction among women undergoing nonsurgical therapy for stress urinary incontinence. The study showed college education and no previous urinary incontinence surgery as predictors of success based on the stress subscale of the Pelvic Floor Distress Inventory. Also identified are menopause and lower incontinence frequency as predictors of success and satisfaction.

The article focuses on a study which investigated demographic and clinical predictors of midurethral sling failure in women with stress urinary incontinence (SUI). The study found that overall odds of midurethral sling failure are more common with women with previous incontinence surgery, more severe urinary incontinence symptoms, and urethral hypomobility. Pad weight testing was also considered to be a powerful predictor of midurethal sling failure.

The article presents a study on the relationship between menopause transition stage and the development of urinary incontinence symptoms. It notes that data of 1.529 women with no reported incontinence at baseline in the Study of Women's Health Across the Nation (SWAN) were analyzed. Results show that infrequent symptoms of incontinence can be attributed to perimenopause. Moreover, it also notes that the development of frequent incontinence is associated with diabetes and weight gain.

The article presents a study on the effect of transobturator tape on the symptoms of overactive bladder (OAB) and of urge urinary incontinence in women with mixed urinary incontinence (UUI). It reveals the use of two sets of questionnaires and of Verbal Analogue Satisfaction (VeAS) scale during the telephone interviews. It says that improvement or marked resolution in urge incontinence is observed after the process of transobturator tape and that there is no de novo urge incontinence identified.

The article compares the effectiveness of tension-free vaginal tape with the effectiveness of transobturator tape (TVT) in 164 women with stress urinary incontinence and intrinsic sphincter deficiency. The researchers found that retropubic TVT is more effective than TVT sling in women with urodynamic stress incontinence.

The article presents a research from the U.S. Centers for Disease Control and Prevention (CDCP) and the World Health Organization (WHO) that summarizes the effect of obesity and outcomes of surgical treatment of pelvic floor disorders. It states that surgery for urinary incontinence (UI) in obese women is safe, but needs more trials in evaluating its long-term effectiveness. It is stated that weight loss should be considered in the treatment of pelvic floor disorders in the obese woman.

The article presents abstracts on medical topics including randomized, controlled trials of nonsurgical treatments for urinary incontinence in women, human papillomarivus infection in women screened for cervical cancer in the U.S. and adherence to a Dietary Approaches to Stop Hypertension (DASH)-style diet and risk of coronary heart disease and stroke in women.

The article presents clinical research on the relationship between anal sphincter tears and the incidence of postpartum fecal incontinence and urinary incontinence in women bearing a child for the first time. One hundred twenty four of the participants delivered by cesarean before labor while 407 had clinically recognized sphincter tears during vaginal delivery.

The article examines the costs of routine care for female urinary incontinence, health-related quality of life, and willingness to pay for incontinence improvement in the United States. Results reveal that women with severe urinary incontinence pay $900 each year for incontinence routine care, and incontinence related to a significant decrement in health-related quality of life. Effective incontinence treatment may reduce costs and enhance quality of life.

OBJECTIVE: To estimate the effect of 2 years of treatment with ultralow-dose transdermal estradiol (1,2) on incontinence in postmenopausal women. METHODS: Ultra Low Dose Transdermal estrogen Assessment (ULTRA) was a multicenter, randomized, double-blinded, placebo-controlled trial of unopposed ultralow-dose (0.014 mg/d) transdermal 1–2 for prevention of osteoporosis in 417 postmenopausal women aged 60 to 80 years. Frequency of incontinence episodes was assessed at baseline and after 4 months and 2 years of treatment using a self-reported questionnaire. We used an intention-to-treat analysis to compare change in incontinence frequency, improved (decreased 2 or more episodes per week), unchanged (increased or decreased no more than 1 episode per week), or worsened (increased 2 or more episodes per week) between the 1,2 and placebo groups among women with and without at (east week(y incontinence at baseline. RESULTS: At baseline, the prevalence of at least weekly incontinence was similar between 1,2 and placebo groups (43%). After 2 years, there was no difference between groups in the proportions of women with incontinence at baseline whose incontinence improved, worsened, or was unchanged. The odds ratio for worsening incontinence in the E2 compared with placebo group was 1.35 (95% confidence interval 0.75–2.42. In women without incontinence at baseline, the odds of developing at least weekly incontinence after 2 years in the 1.2 compared with placebo group was not significant (odds ratio 1.2, 95% confidence interval 0.7–2.2). CONCLUSION: Two years of treatment with unopposed ultralow-dose transdermal E2 did not substantially change the frequency of incontinence symptoms or alter the risk of developing at least weekly incontinence. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To estimate the effect of hormone therapy on risk of stress and urge urinary incontinence. METHODS: The Heart Estrogen/progestin Replacement Study was a randomized, placebo-controlled, double-blinded trial to evaluate daily oral conjugated estrogen (0.625 mg) plus medroxyprogesterone acetate (2.5 mg) therapy fur the prevention of heart disease events in women with established heart disease. The 1,208 participants in Heart Estrogen/progestin Replacement Study who reported no loss of urine in the previous 7 days at baseline are included in this analysis. RESULTS: During 4.2 years of treatment, 64% of women randomly assigned to hormone therapy compared with 49% of those assigned to placebo reported weekly incontinence (P « .001). The higher risk of incontinence in the hormone group was evident at 4 months, persisted throughout the treatment period, and was independent of the age of the women. The odds ratios for weekly incontinence among women on hormone therapy compared with placebo were 1.5 for urge incontinence (95% confidence interval [CI] 1.2-1.8; P « .001) and 1.7 for stress incontinence (95% CI 1.5–2.1; P « .001). Four years of treatment with hormone therapy caused an excess risk of 12% for weekly urge incontinence and 16% for weekly stress incontinence; the corresponding numbers needed to harm were 8.6 (95% CI 5.8–16.6) and 6.2 (95% CI 4.6–9.4). CONCLUSION: Estrogen plus progestin therapy increases risk of urge and stress incontinence within 4 months of beginning treatment. Precis: Estrogen plus progestin therapy increases risk of urge and stress incontinence within 4 months of beginning treatment. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To evaluate the reproducibility, construct validity, and preferences for the 2-item Stress/Urge Incontinence Questionnaire. METHODS: The questionnaire asks a patient to recall the number of stress urinary incontinence and urge urinary incontinence episodes she experienced during the preceding week. The 4-week prospective study included 3 office visits and enrolled women with stress, urge, or mixed urinary incontinence symptoms. The test-retest reproducibility was assessed after 3 days, and the construct validity of the questionnaire was evaluated against a diary and other measures of incontinence severity and effect. The bother associated with completing (patients) or analyzing (physicians) the diary was assessed. Both groups also reported their time requirements and preferences for the questionnaire or diary. RESULTS: Reproducibility for the classification of symptoms was moderately strong (κ = .536). Test-retest agreement was good (64-80%) for all but balanced mixed incontinence (38%). Intraclass correlations revealed good reproducibility for the number of stress (.694), urge (.703), and total (.726) incontinence episodes. Significant (P < .01) correlations with other measures of incontinence established construct validity. Patients and physicians reported it took less time to complete the questionnaire than the diary, but the majority said the completion or analysis of the diary was of little or no bother and preferred the diary. CONCLUSION: The Stress/Urge Incontinence Questionnaire is a valid tool that can be used in clinical practice to differentiate between symptoms of stress and urge urinary incontinence to make an initial diagnosis, especially in primary care where incontinence is not a focus of the practice. [ABSTRACT FROM AUTHOR]

Objective: To compare acupuncture treatment for overactive bladder with urge incontinence with a placebo acupuncture treatment. Methods: Eighty-five women enrolled in this randomized, placebo-controlled trial. Women were randomly assigned to either receive an acupuncture treatment expected to improve their bladder symptoms, or a placebo acupuncture treatment designed to promote relaxation. They underwent cystometric testing, completed a 3-day voiding diary, and completed the urinary distress inventory and incontinence impact questionnaire, validated quality-of-life inventories, before and after 4 weekly acupuncture treatments. The primary endpoint was number of incontinent episodes over 3 days. Secondary endpoints included voiding frequency and urgency, cystometric bladder capacity, maximum voided volume, and the urinary distress inventory and incontinence impact questionnaire symptom scores. Results: Seventy-four women completed all aspects of the study. Women in both treatment and placebo groups had significant decreases in number of incontinent episodes (59% for treatment, 40% for placebo) without a significant difference in the change between the groups. Women in the treatment group had a 14% reduction in urinary frequency (P = .013), a 30% reduction in the proportion of voids associated with urgency (P = .016), and a 13% increase in both maximum voided volume and maximum cystometric capacity (P = .01 ). Both groups also had an improvement in the urinary distress inventory and incontinence impact questionnaire scores (54% decrease for treatment, 30% decrease for placebo, P « .001 for the difference in change between the groups). Conclusion: Women who received 4 weekly bladder-specific acupuncture treatments had significant improvements in bladder capacity, urgency, frequency, and quality-of-life scores as compared with women who received placebo acupuncture treatments. [ABSTRACT FROM AUTHOR]

Objective: To compare outcome of the tension-free vaginal tape (TVT) procedure in women with urinary mixed and stress incontinence. Methods: A mailed questionnaire was answered by 760 of 970 women who had undergone TVT surgery 2–8 years ago (78% response rate). Seventeen women had unclassified incontinence, and 51 women who developed de novo urgency were excluded, giving 580 (83.8%) with stress incontinence and 112 (16.2%) women with mixed incontinence eligible for analysis. Demographic, reproductive factors, and medical history were obtained. The questionnaire included detailed questions about urinary symptoms. Analysis of outcome was done for cohorts by number of years since the operation. Results: The women with stress incontinence had a persistent cure rate of 85% from 2 to 8 years after the TVT procedure. The women with mixed incontinence had a persistent cure rate of 60% up to 4 years postoperatively, but the cure rate then steadily declined to 30% from 4 to 8 years after surgery. The increased rate of incontinence was due to urgency symptoms. Conclusion: The results of this study indicate that initial good cure rates of TVT for mixed incontinence do not persist after 4 years. [ABSTRACT FROM AUTHOR]

Numerous techniques have been developed to evaluate the types and extent of urinary incontinence. A number of treatment options exist, including behavioral medical, and surgical approaches. The purpose of this document is to consider the best available evidence for evaluating and treating urinary incontinence in women. [ABSTRACT FROM AUTHOR]

Obstetrician-gynecologists often care for women with urinary symptoms of urgency and frequency. These symptoms are bothersome and treatable. Although it is rare that serious disease is causative, the clinician must be alert to ominous signs and physical findings. Most patients experience relief of their symptoms after a simple initial evaluation with appropriately directed treatment. A step-wise evaluation includes the directed history and physical, assessment of urinary habits, typically with a urinary diary, and occasionally an assessment of voiding efficiency, typically with a postvoid residual. Treatments may include myofascial therapy when trigger points are present on physical examination. Behavioral therapy and pharmaceuticals also play an important role. Persistent symptoms, hematuria, severe de novo postoperative symptoms, and ominous physical findings may warrant specialty consultation. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To investigate the relationship between urinary incontinence and women's levels and hours of participation in 31 activities. METHODS: A subset of panel members from the Health and Retirement Study completed the self-administered Consumption and Activities Mail Survey questionnaire in 2001. These data were linked with Health and Retirement Study 2000 data. Analyses were limited to 2,190 female Consumption and Activities Mail Survey self-respondents born in 1947 or earlier. Logistic regression was used to predict activity participation. Linear regression was used to predict the number of hours of participation. RESULTS: The hypothesis that urinary incontinence affects women's time use and activity patterns was supported. Compared with the continent women, the incontinent women were less likely to have house cleaned, shopped, physically shown affection, or attended religious services in the recent past; and were more likely to have watched television or made music by singing or playing an instrument. Compared with continent activity participants, incontinent participants reported significantly fewer hours spent walking, communicating with friends and family by telephone or e-mail, working for pay, using a computer, and engaging in personal grooming and hygiene. CONCLUSION: These findings substantiate prior work on the relationship between urinary incontinence and quality of life, and suggest a useful route for educating patients about the impact of urinary incontinence. Clinicians must be alert to opportunities for encouraging incontinent women to be active. It is also important to consider the implications for time use and activity patterns when advising patients about treatment and management options. [ABSTRACT FROM AUTHOR]

Focuses on the causes and effects of changes in genitourinary tract. Loss of characteristic rugated appearance of the vagina; Hormone therapy for atrophic vaginal changes, urinary incontinence and urinary tract infections; Randomized clinical trials.

OBJECTIVE: The objective of this study was 2-fold. The first was to estimate side-to-side variation in antral follicle counts. The second was to determine whether basal follicle-stimulating hormone levels on days 2, 3, and 4 of the same menstrual cycle are significantly different. METHODS: Forty-one patients between the ages of 20 and 42 years undergoing monitoring for in vitro fertilization-embryo transfer were evaluated ultrasonographically for antral follicle number. The antral follicle counts were determined for each ovary by experienced ultrasonographers at the time of suppression check ultrasonography. In a separate study, 62 normal subjects (ages 20-25 and 40-45 years) underwent serial sequential serum follicle-stimulating hormone determinations on days 2-4 of the menstrual cycle, and these levels were compared. RESULTS: There was no significant difference between right and left antral follicle counts (P = .30). Serial follicle-stimulating hormone values were not significantly different on days 2,3, or 4 of the menstrual cycle (P = .22). CONCLUSION: There is no significant difference between right-sided and left-sided antral follicle counts within the same individual. In turn, there is no significant difference in serial follicle-stimulating hormone levels on days 2, 3, or 4 of the menstrual cycle. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To compare objective and subjective outcomes after the tension-free vaginal tape procedure (TVT) with laparoscopic mesh colposuspension as a primary treatment for female stress urinary incontinence. Objective outcome measures were stress test and 48-hour pod test. METHODS: In 6 departments of gynecology in Finland, including 4 university teaching hospitals and 2 central hospitals, 128 women with urodynamic stress incontinence were randomly allocated to 2 treatment groups. Seventy were treated with TVT and 51 by means of laparoscopic mesh colposuspension. There were 7 dropouts. Inclusion criteria were history of stress incontinence, positive stress test, and urodynamic conformation of stress incontinence. Exclusion criteria were age older than 70 years, previous incontinence surgery, more than 3 episodes of urinary tract infection within the last 2 years, coincident other gynecological surgery, body mass index more than 32 kg/m², urethral closure pressure less than 20 cm H2O, and residual volume more than 100 mL in preoperative urodynamic evaluation. Assessment took place before treatment and at 12 months postoperatively with the cough stress test, Urge Score, 48-hour pod test, King's College Health Questionnaire, Visual Analog Scale, and Urinary Incontinence Severity Score. RESULTS: When negative stress test was used as criteria for cure, 85.7% of women in the TVT group and 56.9% in the laparoscopic mesh colposuspension group were objectively cured. Subject satisfaction was significantly better after the TVT procedure than after laparoscopic mesh colposuspension. CONCLUSION: Treatment with TVT results in higher objective and subjective cure rates at 1 year than treatment by means of laparoscopic mesh colposuspension. [ABSTRACT FROM AUTHOR]

OBJECTIVE:To evaluate the outcomes of tension-free vaginal tape in the treatment of primary versus recurrent genuine stress urinary incontinence.METHODS:A retrospective, multicenter study of 245 consecutive women who were treated with tension-free vaginal tape for genuine stress urinary incontinence (157 for primary and 88 for recurrent genuine stress urinary incontinence) over a 27-month period was performed. Concurrent surgical repairs were performed as required. Subjective and objective outcome data were assessed from routine postoperative visits. Office and hospital records were reviewed to determine patient characteristics, intraoperative findings, and surgical outcomes.RESULTS:Women with recurrent genuine stress urinary incontinence were older (mean age 64.6 versus 59.4 years, P = .004) than those with primary incontinence; they were less likely to have an intact uterus (22.7% versus 66.9%, P < .001), and were more likely to have intrinsic sphincter deficiency (70.5% versus 47.1%, P < .001). The mean duration of follow-up was 38 (±16) weeks. Cure rates among patients with recurrent versus primary genuine stress urinary incontinence were similar (85% and 87%, respectively, P = .23). Complication rates were similarly low in both groups (4.5% versus 7.6% for recurrent and primary genuine stress urinary incontinence, respectively, P = .35). Postoperative voiding dysfunction occurred at low rates in both groups.CONCLUSION:Tension-free vaginal tape is a highly effective treatment among patients with recurrent stress incontinence, with outcomes comparable with those among patients with primary incontinence. [Copyright &y& Elsevier]

OBJECTIVE:To compare the prevalence of urinary incontinence symptoms among black, white, and Hispanic women.METHODS: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?”RESULTS: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).CONCLUSION:The prevalence of incontinence symptoms is significantly different among black, Hispanic, and white women. [Copyright &y& Elsevier]

The article presents a case study of a 43-year-old premenopausal woman who exemplifies vaginal mesh after subjection on the tension-free vaginal tape (TVT) procedure to treat her urinary incontinence, urgency and frequency for one year. It mentions that because of the ineffective treatment, Martius graft procedure was undertaken. The result shows that the Martius procedure enables to protect the sling, thereby preventing recurrence of urinary incontinence.

The article offers developments related to obstetrics and gynecology as of June 2007 based on data from various U.S. federal agencies. As part of the Stillbirth Collaborative Research Network, 58 hospitals have been enrolling patients with stillbirths in a major study. A clinical trial involving 450 women was conducted to determine which treatment reduces stress urinary incontinence effectively.