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Objectives: This study aims to determine the effects of transurethral polyacrylamide hydrogel injection in patients considered ineligible for midurethral sling surgery., Methods: In this prospective observational study, 81 patients received treatment with transurethral polyacrylamide hydrogel injection. Patients were considered ineligible for placement of a midurethral sling based on significant comorbidity (48%), 1 or more previously failed invasive treatments (16%), mixed urinary incontinence (27%), continuous incontinence (5%), or previous pelvic radiation therapy (4%). Longitudinal assessment of subjective treatment outcomes was performed using the validated Urinary Distress Inventory (UDI) and the Pelvic Floor Impact Questionnaire at baseline, 2, and 6 months. To deal with repeated measurements, mixed linear models were used to assess changes in the outcomes over time., Results: There was a significant improvement in the overall UDI score from baseline to month 2 follow-up (FU) (P<0.001). No major differences between the month 2 and 6 FUs were observed. The largest difference in effect was observed for the irritative and stress subscales. Twenty-five patients (33%) requested a second injection at the month 2 FU visit. At month 6 FU, the UDI scores for patients having had only 1 injection were largely unchanged, whereas all UDI domains worsened further for patients having had a second injection at the month 2 visit. After the injection, there were 3 minor adverse events (3.7%) and no serious adverse events., Conclusions: In patients considered ineligible for midurethral sling surgery, transurethral injection with polyacrylamide hydrogel may alleviate urinary incontinence symptoms. Repeat injections did not improve outcomes in this complicated group of patients.

Introduction and Hypothesis: The aim of this study is to evaluate the effect of birth weight and being born small for gestational age (SGA) on urinary incontinence (UI) among premenopausal women., Methods: In 2005, a total of 14,094 female twins born 1959-1985 who had been included in the Swedish Twin Registry participated in a survey on common exposures and complex diseases, including urinary incontinence. Information regarding birth weight and gestational age was obtained from the Medical Birth Register (for twins born 1973-1985) and from the medical archives (for twins born 1959-1972). A logistic regression model based on generalized estimating equations was used to estimate odds ratios (ORs) with 95 % confidence intervals (CIs)., Results: In both crude and adjusted analysis, birth weight and SGA had no effect on UI. An interaction between low birth weight (<2,500 g) and body mass index (BMI) later in life was found for overall and stress UI. Compared with women who were not overweight and had a birth weight above 2,500 g, overweight women (BMI ≥ 25) who had a normal birth weight had a 35 % higher odds of incontinence , while overweight women who had a low birth weight had an approximately 85 % higher odds of UI (OR = 1.84, 95 % CI 1.39-2.45 for overall UI; OR = 1.83, 95 % CI 1.35-2.48 for stress UI)., Conclusions: Birth weight and SGA had no direct effect on urinary incontinence; however, low birth weight in combination with an elevated adult BMI may contribute to the risk of urinary incontinence later in life.

Background: The relative importance of genetic and environmental factors for the occurrence of lower urinary tract symptoms (LUTS) is poorly understood., Objective: To (1) estimate the prevalence of urinary incontinence (UI), overactive bladder (OAB), and other LUTS and (2) to assess the heritability of these symptoms., Design, Setting, and Participants: Cross-sectional survey of LUTS in a national population-based cohort of Swedish twins 20-46 yr of age (n=42 582) from the Swedish Twin Registry., Measurements: Prevalence rates were determined and heritability of LUTS (in female twins) was assessed using indicators of twin similarity., Results and Limitations: A total of 25 364 twins completed the questionnaire (response rate: 59.6%). LUTS were more common in women (UI: 7%; OAB: 9%; nocturia: 61%; micturition frequency: 18%) than in men (UI: 1%; OAB: 5%; nocturia: 40%; micturition frequency: 11%), and prevalence increased with age. The strongest genetic effects were observed for UI, frequency, and nocturia. The lowest estimate for genetic effects was observed for OAB where environmental effects dominated, and more specifically shared family environment accounted for a third or more of the total variation. For stress UI, a fifth of the total variation in susceptibility to the disorder could be attributed to shared environment. Nonshared environmental effects were seen in the range of 45-65% for the various LUTS. The prevalence of LUTS was low in the men, and there were too few male cases to compute measures of similarity or heritability estimates., Conclusions: This study provides robust evidence of a genetic influence for susceptibility to UI, frequency, and nocturia in women. In contrast, shared environmental factors seem more important for the predisposition to develop OAB, which may reflect familial patterns such as learning from parental behaviours., (Copyright © 2011 European Association of Urology. Published by Elsevier B.V. All rights reserved.)

Objective: To assess the impact of oral contraceptives on lower urinary tract dysfunction in premenopausal women., Design: Nationwide cohort study., Setting: National registry., Patient(s): A total of 10,791 women (born 1959-1985) from the population- based Swedish Twin Registry who participated in a web-based survey of common diseases., Intervention(s): None., Main Outcome Measure(s): Symptoms of urinary incontinence., Result(s): For users of oral contraception there was a significantly reduced risk for symptoms of stress urinary incontinence, mixed urinary incontinence, and urgency urinary incontinence. The reduction remained significant when adjusting for age, body mass index, and pregnancy history. A reduced prevalence of symptoms of overactive bladder in oral contraceptive users was also observed although the association was nonsignificant. There were no significant associations between lower urinary tract symptoms and women using a levonorgestrel-releasing intrauterine device compared with noncontraceptive users, with the exception of nocturia., Conclusion(s): Oral contraceptive use reduces the overall risk for symptoms of urinary incontinence.

Objective: The objective of the study was to compare the prevalence of incontinence disorders in relation with spontaneous vaginal delivery or cesarean section., Study Design: Two hundred women with spontaneous vaginal deliveries only were compared with 195 women with cesarean deliveries only 10 years after first delivery., Results: When compared with cesarean section, vaginal delivery was associated with an increased frequency of stress urinary incontinence (P = .006) and an increased use of protective pads (P = .008) as well as an increased frequency of fecal urgency (P = .048) and gas incontinence (P = .01). At multivariate regression analysis, mode of delivery showed no significant association with incontinence symptoms other than an increased risk for flatus incontinence in women with a history of obstetric anal sphincter injury (odds ratio 3.1; 95% confidence interval, 1.5 to 8.9)., Conclusion: Incontinence symptoms are more common following spontaneous vaginal delivery when compared with cesarean section 10 years after first delivery. However, cesarean section is not associated with a major reduction of anal and urinary incontinence.

Objectives: To perform a prospective evaluation of the long-term effects of hysterectomy on symptoms of urinary incontinence., Methods: A prospective observational cohort study was performed. Preoperatively, 120 consecutive patients undergoing hysterectomy for benign conditions answered a questionnaire on symptoms associated with urge and stress urinary incontinence. Of the 120 patients, 44 underwent vaginal and 76 abdominal hysterectomy. Follow-up questionnaires were administered at 1 and 3 years postoperatively., Results: Postoperatively, the questionnaire was answered by 115 (96%) of 120 patients after 1 year and by 107 (89%) after 3 years of follow-up. At surgery, the mean patient age was 49.5 years (range 32 to 78). In the abdominal hysterectomy cohort, a tendency was found for decreased episodes of urinary incontinence, although the difference was not significant. No significant changes were noted in micturition frequency. In the vaginal hysterectomy cohort, no significant changes were detectable in the symptoms associated with urge or stress incontinence, and no significant changes were noted in micturition frequency. For the entire hysterectomy group, a significant decrease occurred in stress urinary incontinence symptoms (P = 0.03). Subgroup analysis did not identify any particular risk factors for the development of urinary incontinence after hysterectomy., Conclusions: In contrast to the results of several studies, the results of our 3-year prospective study showed that total hysterectomy, independent of route, was not associated with an increase in urge or stress urinary incontinence symptoms.

The aim of this study was to prospectively evaluate the effect of vaginal and abdominal hysterectomy on lower urinary tract symptoms. We interviewed 120 patients undergoing hysterectomy for benign conditions preoperatively using a standardized questionnaire. At 6.6 and 12.7 months, 119/120 and 115/120 patients completed the follow-up questionnaire. Forty-four patients underwent vaginal and 76 abdominal hysterectomy. At 6 months follow-up there was a decrease ( p<0.05) in symptoms of stress urinary incontinence in the abdominal cohort, but this did not remain at 12 months' follow-up. There were no significant changes in symptoms of stress urinary incontinence in the vaginal cohort at either 6 or 12 months' follow-up. Postoperative micturition frequency was reduced in both cohorts. No significant differences were found regarding symptoms of urge urinary incontinence, urge complaints or voiding difficulties. The present study does not support the assumption that abdominal or vaginal hysterectomy is associated with de novo or deteriorating symptoms of urinary incontinence.

Purpose: The aim of this study was to compare long-term effects of high-volume surgery at a single-center to multicenter use when using a mesh-capturing device for pelvic organ prolapse (POP) repair. Methods: Five years after surgery 101 (88%) at the single center were compared with 164 (81.2%) in the multicenter trial. Outcome measurements included clinical examination, prolapse-specific symptom questionnaires [Pelvic Floor Distress Inventory 20 (PFDI-20), Pelvic Floor Impact Questionnaire—short form (PFIQ-7), Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12)] and pain estimation by VAS (0–10). Results: Optimal apical segment outcome was 95% in the single- compared to 83.3% in the multicenter study (p < 0.001). POP recurrence in the anterior and posterior walls (POP-Q, Ba and Bp ≥ 0) was more common at the multicenter as compared to the single center [(19.8% vs 5.4%) and (26% vs 2.7%), (p < 0.001)]. Reoperations for POP and mesh-related complications were more frequent in the multicenter study [31/202 (15.3%) vs 7/116 (6.1%), p < 0.001]. Total PFDI-20, PFIQ-7 and PISQ-12 scores were comparable between the cohorts. There were no significant differences in overall pain scores in-between the cohorts during follow-up. At the single center, 1/81 patients (1.2%) had VAS 7/10, i.e. severe pain, as compared to 3/131 (2.3%) in the multicenter study (p = 0.277). Conclusions: Despite the high objective and subjective long-term effectiveness of the procedure in both regular use, and at a high-volume center, centralizing the use of a standardized capturing-device guided transvaginal mesh for POP repair reduced secondary interventions by more than half. [ABSTRACT FROM AUTHOR]

Previous studies have found that major depression and neuroticism are positively associated with urinary incontinence (UI). However, the genetic contribution to these associations has never been investigated. In 2005, a total of 14,094 female twins born 1959–1985 in the Swedish Twin Registry participated in a comprehensive survey on common exposures and complex diseases. Structured questions provided information on UI, depressive symptoms, major depression, and neuroticism. A logistic regression model based on generalized estimating equations (GEE) was used to estimate odds ratios (ORs) with 95% confidence intervals (CIs). Environmental and genetic influences were assessed in co-twin control analyses and quantitative genetic analyses, which were also used to determine the proportion of the phenotypic correlation explained by familial factors. Major depression, depressive symptoms, and neuroticism were positively associated with all UI subtypes (overall, stress, urge, and mixed UI). In a trivariate Cholesky model with neuroticism, depressive symptoms (or depression), and UI a modest genetic correlation was found between indicators of depression and overall, or stress, UI. The majority of this correlation was independent from neuroticism. In contrast, the genetic factors shared between indicators of depression and urge or mixed UI were entirely in common with neuroticism. In conclusion, depression and neuroticism are associated with UI among premenopausal women: the associations are in part determined by genetic factors in common to the disorders. [ABSTRACT FROM PUBLISHER]

This article reports on the findings of a study to see if women who have had a hysterectomy face an increased risk for lower-urinary-tract sequela. In Great Britain, hysterectomy is the preferred treatment option of several benign diseases such as menometrorrhagia, uterine prolapse, adenomyosis and postmenopausal bleeding. In the U.S. there are 600,000 hysterectomies performed annually, most of which are done for benign indications. The study, conducted in Sweden, found that women who had the surgery were at an increased risk for later stress-urinary-incontinence surgery and therefore alternate treatment options should be explored before the surgery option.

Summary: Aims: To estimate the prevalence and severity of nocturia and lower urinary tract symptoms in obese women and to identify risk factors associated with nocturia in an obese population. Methods: We performed a case–control study based on the registry of a university hospital obesity unit. A consecutive sample of women with body mass index ≥30 (obese) was randomly matched by age, gender and residential county to control subjects using the computerised register of the total population. Data were collected by a self-reported postal survey. Results: The questionnaire was completed and returned by 279/446 of the patients (62%) and 430/892 control subjects (48%). Compared to the non-obese control group, obese women reported a significantly increased prevalence and bother of nocturia (p <0.001), frequent urination (p <0.001) and bothersome experience of urination (p =0.037). Moreover, they experienced significantly increased frequency of urinary urgency (p <0.001), of urge urinary incontinence (p <0.001) and of bladder emptying difficulties (p =0.002). The adjusted odds ratio (95% CI) in obese women was 2.8 (1.0–7.9) for nocturia, 4.7 (1.5–14.6) for frequent urination, 5.5 (1.7–17.2) for strong urge to empty bladder and 7.2 (2.2–23.3) for urine leakage related to the feeling of urgency. Conclusion: Obese women are at substantially increased risk for nocturia and overactive bladder symptoms. [Copyright &y& Elsevier]

The article presents clinical research on the risk of urinary incontinence and urinary stress incontinence after the first childbirth, subsequent deliveries, and obstetric events. Two hundred and forty six primiparous women participated in this ten-year prospective cohort study. Results suggest maternal age and number of deliveries do not influence risk.

This case series aims to determine the feasibility of performing a tension-free vaginal tape procedure after failed transurethral injection treatment in women with stress urinary incontinence. [ABSTRACT FROM AUTHOR]

OBJECTIVE -- To determine the diabetes- and obesity-related risks for surgically managed stress urinary incontinence and pelvic organ prolapse. RESEARCH DESIGN AND METHODS-- This twin cohort study used the Swedish Twin Register to identify 8,443 female twin pairs born from 1926 through 1958. The association between diabetes and pelvic floor surgery was estimated while taking into account the correlated (twin) structure of the data. RESULTS-- For type 1 and type 2 diabetes, no significant associations were observed for stress urinary incontinence (odds ratio [OR] 1.0 [95% CI 0.1-9.2] and 2.0 [1.0-4.0], respectively). There were no cases of prolapse surgery in type 1 diabetic subjects, and for type 2 diabetes the risk estimate was nonsignificant (1.6 [1.0-2.71). BMI >25 kg/m², age ≥60 years, and childbirth were the strongest risk factors for having incontinence surgery. CONCLUSIONS-- Out data suggest that diabetes is not associated with stress urinary incontinence or pelvic organ prolapse surgery. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented as a reply to a comment on an article concerning the risk of urinary incontinence after childbirth.

Objective: The purpose of this study was to compare the risk of surgically treated stress urinary incontinence (SUI) and pelvic organ prolapse (POP) in relation to mode of delivery and age at first childbirth. Study Design: This was a cohort study. Data from the Swedish Medical Birth Register on women with only cesarean delivery (n = 30,880 women) or only vaginal delivery (n = 59,585 women) were compared with the Swedish Patient Register to calculate incidence rates and hazard ratios (95% confidence interval [CI]) for SUI and POP surgery. Results: In analyses that were stratified by age, vaginal delivery consistently increased the risks of SUI and POP surgery. Among vaginally delivered women who were ≥30 years old, incidence rates of POP surgery were 13.8 (95% CI, 12.7–15.1), and for younger women were 6.4 (95% CI, 6.0–6.8) per 10,000 person-years. Exclusion of instrumental vaginal delivery did not alter the conclusions. Conclusion: Increasing age at first delivery increased the risk of subsequent SUI and POP surgery after both vaginal and cesarean delivery. [ABSTRACT FROM AUTHOR]