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Abstract: 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 &y& Elsevier]

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]

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]

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. [ABSTRACT FROM AUTHOR]

Abstract: 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. [Copyright &y& Elsevier]