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Stress urinary incontinence and stress-predominant mixed urinary incontinence are prevalent conditions that significantly impair quality of life, particularly among women. Urethral bulking agents have emerged as a non-surgical treatment option for patients who are hesitant to undergo surgical interventions. The aim of this systematic review and meta-analysis is to evaluate the efficacy and safety of various urethral bulking agents, specifically Bulkamid, Macroplastique, and Urolastic, in treating stress urinary incontinence and stress-predominant mixed urinary incontinence. The review encompasses 15 studies, including rando­mized controlled trials and cohort studies, with a total of 1,120 patients. The analysis focuses on cure and improvement rates, complications, and the risk of bias associated with the included studies. The fin­dings indicate that bulking agents demonstrate cure and improvement rates ranging from 70 to 80 %, with a pooled average of 75 %. Subgroup analyses reveal cure rates of 76 % for Bulkamid, 73 % for Urolastic, and 77 % for Macroplastique. Despite significant statistical heterogeneity, particularly for Bulkamid and Urolastic, the results suggest that these agents can serve as effective non-surgical options. The outcomes appear consistent across all continents included in this study, reinforcing their potential as reliable alternative glo­bally. Ho­wever, the review highlights the necessity for well-designed randomized controlled trials to further assess the long-term efficacy and safety of these treatments, ultimately aiming to optimize patient outcomes.

Abstract Background Urinary incontinence (UI) is defined as any involuntary leakage of urine. UI during pregnancy is a common health problem worldwide with prevalence ranging from 11.4 to 84.5%. In Ethiopia there has been limited research conducted on UI among pregnant women. The purpose of this study was to investigate the prevalence of UI, factors associated with UI and the impact on quality of life in pregnant women. Method Cross-sectional study was conducted from December 1, 2022 to April 30, 2023. A total of 279 pregnant women attending Antenatal care were included. Data was entered into Epi-data version 3.1 and then exported to SPSS version 26 for cleaning and analysis. Chi-square test and logistic regression were done to look for factors associated with UI. We used 95% confidence interval of crude and adjusted odds ratios for analysis. Those variables with P-value

Male urinary incontinence (UI) is a prevalent yet under-discussed condition that has a significant impact on patient quality of life and social, emotional and physical well-being. UI in men can arise as stress incontinence, urge incontinence, or mixed incontinence depending on the timing and manifestation of urinary leakage. The economic implications of UI are substantial, with UI in men leading to billions in healthcare costs annually in the United States alone. UI is associated with decreased quality of life and depression, particularly among socioeconomically vulnerable populations. For men, this condition can cause emotional and financial distress, affecting quality of life, social reintegration, and professional activities. Addressing the mental health aspects of UI through screening, open communication, and tailored interventions is crucial for improving patient outcomes and quality of life. The diagnostic process for UI begins with a thorough history and physical examination to classify the type and severity, which dictates the treatment approach. Other office-based diagnostic tools can help to accurately characterize symptoms and assess impact on quality of life. For complex cases or when standard diagnostics fail to clarify the condition, referrals to urologic specialists for advanced testing are recommended. Conservative management is always preferred as the first-line therapy for UI, including for stress, urge and mixed incontinence. Medications tend to be more effective and prevalent in the management and treatment for urge incontinence while surgical interventions are likely to give the best outcomes for stress incontinence. Referral to a urologic specialist is often necessitated in complex cases or for surgical treatment of UI. In this study, we provide a comprehensive analysis of male UI, enhance understanding and awareness of the condition, guide management practices to improve patient outcomes, and explore the economic burden and mental health implications of UI in men.

[Display omitted] Urinary incontinence (UI) is a disease that quietly yet seriously impacts women's health and represents a global health burden that is often neglected. This study aims to systematically assess the prevalence and dynamics of female UI in China, and can inform further policies and have international implications. This study used three nationwide investigations: A national cross-sectional survey in 2021; another nationwide cross-sectional survey in 2006; and data regarding the institutions and physicians providing pelvic floor rehabilitation services from 2005 to 2019. The weighted prevalence of female UI and its subtypes, including stress UI (SUI), urgency UI (UUI), and mixed UI (MUI), were estimated as primary outcomes. Knowledge, attitude and care-seeking behaviors of UI were evaluated. It was found that the weighted prevalence of female UI was 16.0 % (95% CI, 13.3 %–19.1%) with SUI remaining the predominant subtype (7.0%) in 2021, followed by MUI (6.5%) and UUI (1.9%). The estimated absolute number of Chinese adult women with UI was 85.8 million in 2021. 52.7% (95% CI, 45.9%–59.4 %) of women were aware that UI was a medical condition, and only 10.1% of women with UI sought health care. After 15 years of development, there were 8400 pelvic floor rehabilitation institutions and nearly 10,000 relevant physicians in China—they were found to be associated with UI prevalence. The UI prevalence in China was significantly lower in 2021 compared to that in 2006. Despite the achievement, UI remains a public health problem, especially given China's fast aging and three-child policy. More innovations, especially those that can facilitate care seeking, are needed to address this prevalent yet treatable condition. [ABSTRACT FROM AUTHOR]

Background/Objectives: The most common variant of mixed urinary incontinence is stress-induced urge urinary incontinence with the correlating urodynamic findings of cough-induced detrusor overactivity (CIDO). This prospective study assessed the clinical outcomes and leakage improvement among patients with CIDO following conservative or surgical treatment. Methods: We included patients with CIDO treated at our tertiary referral center from January 2018 to July 2021 in this prospective cohort study. The detection of a detrusor contraction after a cough was diagnosed as CIDO by urodynamic multichannel testing. All the patients in our study received personalized care, with behavioral therapy and anticholinergic/betamimetic treatment as a first step. If leakage persisted, patients were given a choice between pelvic floor muscle exercises (PFMEs), periurethral bulking or a midurethral sling. The primary outcome was the mean difference in urine leakage in the pad test before and six months after treatment. Results: Thirty-five patients met the inclusion criteria for CIDO and all presented a positive pad test at baseline (mean: 27 g). All 35 patients participated in behavioral therapy and anticholinergic/betamimetic treatment. Twenty-two patients (62.9%) underwent PFME, twelve patients (34.2%) received periurethral bulking, and nine patients (25.7%) received a midurethral sling. After all the treatments, our cohort showed a significant improvement in the pad test (mean: 5.7 g, p < 0.001). The result was more favorable after periurethral bulking than the midurethral sling (p < 0.001). Conclusions: This study shows the effectiveness of conservative treatment as a first step. In cases needing further treatment, bulking agents may be superior to PFME and midurethral propylene slings, offering new perspectives in the field of urogynecology and urinary incontinence. [ABSTRACT FROM AUTHOR]

Objective: To investigate how reproductive history was associated with urinary incontinence in midlife. Design: A follow‐up study. Setting: Denmark. Population: A total of 39 977 mothers who participated in the Maternal Follow up (2013–2014) in the Danish National Birth Cohort. National registries provided their reproductive history. Methods: How parity, mode of birth and obstetric tears associated with urinary incontinence were estimated with adjusted odds ratios (OR) and 95% CI using logistic regression. Main outcome measures: Self‐reported urinary incontinence including subtypes stress, urge and mixed urinary incontinence. Results: At an average age of 44 years, the prevalence of any urinary incontinence was 32% (21% stress, 2% urge, and 8% mixed urinary incontinence). Women with two births more often had urinary incontinence than women with one birth (OR 1.20, 95% CI 1.10–1.31). Compared with women with only spontaneous births, a history of only caesarean sections was associated with much lower odds of urinary incontinence (OR 0.39, 95% CI 0.35–0.42) and a history of instrumental births with slightly lower odds (OR 0.92, 95% CI 0.86–0.98). Compared with no tear/first‐degree tear as the largest tear, episiotomy was associated with less urinary incontinence (OR 0.91, 95% CI 0.86–0.97) whereas third/fourth‐degree tears were associated with more (OR 1.14, 95% CI 1.04–1.25). Findings were mainly explained by similar associations with stress and mixed urinary incontinence. Conclusions: Vaginal birth was associated with a higher risk of long‐term urinary incontinence, but our results indicate that this risk may be reduced by shortening the second stage of birth. [ABSTRACT FROM AUTHOR]

Background: Mixed urinary incontinence (MUI) has always represented a major therapeutic challenge and the management of this type of incontinence is often complicated by uncertain outcomes. Surgical options include interventions targeting both stress urinary incontinence (SUI) and urge urinary incontinence (UUI), although there are no international published guidelines that dictate whether it is better to start with surgical management to address the SUI or UUI component after the failure of conservative treatment. The aim of the present study is to evaluate the effectiveness of the Macroplastique (MPQ) procedure on overactive bladder (OAB) symptoms in women with MUI with a minimum follow-up of 1 year. Methods: A retrospective analysis of prospectively collected data was performed in two tertiary reference centers. We enrolled all women complaining of symptoms of SUI and OAB, dry or wet, with a urodynamically confirmed diagnosis of MUI [urodynamic stress incontinence (USI) with detrusor overactivity (DO)], who took a previous ineffective antimuscarinic treatment and underwent the MPQ procedure. We considered as objectively cured women who did not leak urine during the stress test and with a 1 h pad-test negative, while International Consultation on Incontinence Questionnaire–Short Form (ICIQ-SF), ICIQ-OAB, Patient Global Impression of Improvement (PGI-I) scale, and a Visual Analogue Scale (VAS) were used to assess subjective outcomes. Results: A total of forty-six patients who met the inclusion criteria and who underwent the MPQ procedure were considered for the analysis. At the 1-year mark of follow-up, 72% of patients were objectively cured at stress test and 65% were objectively cured at pad-test, while 72% of women declared themselves subjectively cured. OAB symptoms significantly improved after MPQ and a complete resolution of OAB was recorded in 35% of patients. Conclusions: This study demonstrated that MPQ is a safe and effective option for the treatment of female MUI. Furthermore, MPQ significantly improves the symptoms of OAB and is able to completely cure this condition in a relevant percentage of women with MUI when pharmacological treatment fails. [ABSTRACT FROM AUTHOR]

Stress urinary incontinence and stress-predominant mixed urinary incontinence are prevalent conditions that significantly impair quality of life, particularly among women. Urethral bulking agents have emerged as a non-surgical treatment option for patients who are hesitant to undergo surgical interventions. The aim of this systematic review and meta-analysis is to evaluate the efficacy and safety of various urethral bulking agents, specifically Bulkamid, Macroplastique, and Urolastic, in treating stress urinary incontinence and stress-predominant mixed urinary incontinence. The review encompasses 15 studies, including randomized controlled trials and cohort studies, with a total of 1,120 patients. The analysis focuses on cure and improvement rates, complications, and the risk of bias associated with the included studies. The findings indicate that bulking agents demonstrate cure and improvement rates ranging from 70 to 80 %, with a pooled average of 75 %. Subgroup analyses reveal cure rates of 76 % for Bulkamid, 73 % for Urolastic, and 77 % for Macroplastique. Despite significant statistical heterogeneity, particularly for Bulkamid and Urolastic, the results suggest that these agents can serve as effective non-surgical options. The outcomes appear consistent across all continents included in this study, reinforcing their potential as reliable alternative globally. However, the review highlights the necessity for well-designed randomized controlled trials to further assess the long-term efficacy and safety of these treatments, ultimately aiming to optimize patient outcomes. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to evaluate the efficacy and safety following treatment with Bulkamid for stress urinary incontinence (SUI) or stress-predominant mixed urinary incontinence (MUI). Methods: We retrospectively analyzed data of women diagnosed with SUI or stress-predominant MUI who underwent Bulkamid periurethral injection between November 2020 and January 2023 and completed 12 months of follow-up. The primary outcome of the study was to assess patient satisfaction, which was measured on a four-point scale, ranging from cured to worse, and through validated questionaries such as the International Consultation on Incontinence Questionnaire-short Form (ICIQ-UI SF) and Contilife Quality of Life questionnaire. Results: Of the 70 patients included, 41 (59%) had MUI with predominant stress incontinence. Median age was 59 years (IQR 47–75), with a median BMI of 25 (18–40) and a median number of pregnancies of 2 (0–4). Forty-seven (67%) procedures were performed under sedation and 23 (33%) under local anesthesia. Forty-three (69%) women reported feeling cured or improved at 12 months follow-up and among them, 25 (40%) reported feeling cured. A total of 16 (23%) patients were subsequently treated, in detail 11 (16%) patients underwent MUS positioning, and 5 (7%) had an additional injection of Bulkamid. ICIQ and Contilife QoL showed a significant improvement at 1, 3, 6, and 12 months (all p < 0.001). Conclusions: Bulkamid injections are an effective and safe treatment option for women with SUI or stress-predominant MUI, providing good outcomes at 12 months. [ABSTRACT FROM AUTHOR]

Background: Urinary incontinence (UI) is defined as any involuntary leakage of urine. UI during pregnancy is a common health problem worldwide with prevalence ranging from 11.4 to 84.5%. In Ethiopia there has been limited research conducted on UI among pregnant women. The purpose of this study was to investigate the prevalence of UI, factors associated with UI and the impact on quality of life in pregnant women. Method: Cross-sectional study was conducted from December 1, 2022 to April 30, 2023. A total of 279 pregnant women attending Antenatal care were included. Data was entered into Epi-data version 3.1 and then exported to SPSS version 26 for cleaning and analysis. Chi-square test and logistic regression were done to look for factors associated with UI. We used 95% confidence interval of crude and adjusted odds ratios for analysis. Those variables with P-value < 0.05 were declared to be statistically significant. Result: Overall prevalence of UI was 18.6% (n = 52). Prevalence of each type of UI during pregnancy was 9.3% for Stress UI, 5% for Urge UI and 4.3% for mixed UI. Of all participants having UI, 2(3.8%) were having UI prior to pregnancy, while 3(5.8%), 16(30.7%) and 31(59.6) have encountered during first, second and third trimester respectively. Three fourth of the participants 38(73.1%) doesn't seek treatment for their UI. Presence of history of UI [AOR = 38.1, 95%CI: (7.95, 182.75)], previous history of instrumental delivery [AOR = 7.4, 95%CI: (3.05, 18.04)] and history of alcohol intake [AOR = 17.0, 95%CI: (1.49, 194.41)] were found to be significantly associated with UI while moderate severity UI [AOR = 12.9, 95%CI (1.46, 113.28)] and severe UI [AOR = 27, 95%CI (1.98, 138.38)] were significantly associated with Poor quality of life at p-value of < 0.05. Based on severity score UI was moderate in 34 (65.4%) and severe in 8 (15.4%) of the participants. Conclusion: UI affects one fifth of pregnant women (18.6%) and Stress UI is the most common type of UI during pregnancy. Previous history of UI, instrumental delivery and alcohol intake were found to be risk factors for UI. Pregnant women have to be advised to avoid or reduce alcohol consumption and to seek treatment for their problem. Follow up throughout pregnancy and postpartum period is very important to plan for further management of UI. [ABSTRACT FROM AUTHOR]

Background: Stress urinary incontinence (SUI) affects around 35% of adult women and has a significant impact on quality of life. A single incision sling (SIS), such as Altis®, was introduced to improve original slings and avoid complications. The present study aimed to evaluate the SIS Altis® subjective and objective cure rates of women with SUI, mixed urinary incontinence (MUI), recurrent SUI, and SUI with concomitant prolapse and report its complications from one single medical center. Methodology: A retrospective cohort, unsponsored study was conducted at the Jordan University Hospital. All women patients were treated with the SIS Altis® procedure, and prolapse procedures were also completed as necessary. The chi square analysis for the cure rates was conducted between the subgroups. Results: From June 2016 to June 2019, 111 women patients with a mean age of 48.0 ± 11.3 years underwent a SIS Altis® procedure. The overall outcome resulted in 81% and 85% of patients being subjectively and objectively cured. The subjectively cured MUI patients were significantly fewer than SUI patients (70% versus 86%, p < 0.05), and patients with recurrent SUI had significantly lower rates (56% for subjective and objective cure rates; p < 0.01 and 0.001). Of the 44 patients who underwent SIS Altis® and concomitant vaginal repair surgery, no significant differences in subjective and objective cure rates were observed. Only 2.7% of women had mild pain, 2.7% had vaginal tape erosion, and 9% had to be re-operated on. Conclusions: The Altis® procedure is effective in women who suffer from SUI for a 19-month follow-up period. However, recurrent SUI patients had lower subjective and objective cure rates than primary SUI patients. Further research is needed with a larger sample size in a prospective study design to determine the effectiveness of single SIS in patients with recurrent SUI. [ABSTRACT FROM AUTHOR]

Purpose/Objective: Mixed urinary incontinence (MUI) is the coexistence of stress urinary incontinence (SUI) and urge urinary incontinence (UUI). MUI can be a challenging condition to treat, and there continues to be a demand for successful nonsurgical interventions if possible. This study evaluates the efficacy of combining bipolar radiofrequency (RF) energy to the vaginal canal, electrical muscle stimulation (EMS) of the pelvic floor, and patient education in the treatment of MUI in females. Methods: A prospective study that evaluates RF and EMS in female patients with moderate MUI. RF and EMS treatments were administered three times, 2 weeks apart. Patients were also educated on exactly what MUI is and how to appropriately utilize their pelvic floor muscles. Outcome measures assessed included both objective (cough stress test to measure pad weight) and subjective (Incontinence Quality of Life [iQOL]; Medical, Epidemiological, and Social Aspects of Aging [MESA] Urge Incontinence [UI], MESA Stress Incontinence [SI], Female Sexual Function Index [FsFI]; and Urogenital Distress Inventory-6 [UDI-6]). Results: In total, 31 women underwent the combination of RF, EMS, and patient education, resulting in significant improvement in MUI symptoms (PGI: 82% indicated feeling improvement) after 3 months of treatment in all measures. Conclusion: RF and EMS in conjunction with patient education via a three-treatment protocol was found to be efficacious and safe for treating women with MUI. Future studies should be done to further elucidate optimal treatment protocols for MUI and patients followed up for longer periods of time to determine the durability of this regimen. [ABSTRACT FROM AUTHOR]

Stress urinary incontinence (SUI) and mixed urinary in)continence (MUI) are common conditions affecting the women’s quality of life. The surgical management of SUI is considered when conservative measures fail. Candidates for surgery include women with simple SUI or a primary stress component in MUI after the adequate management of urgency symptoms. Surgical decision-making factors include intrinsic sphincter deficit, urethral hypermobility, previous conservative treatments, concurrent procedures, lifestyle, age, general health, and prior pelvic surgeries. A thorough discussion about potential complications, including surgical failure, injury, retention, erosion, infection and voiding difficulties, is essential for an informed decision-making. Surgical options include retropubic colposuspension, Burch colposuspension (open, laparoscopic, or robotic), and tension-free mid-urethral slings (MUS), such as TVT and TVT-O, which are gaining popularity due to their minimal invasiveness, comparable success rates, and lower morbidity. Autologous fascial slings and bulking agents are reserved for specific cases like intrinsic sphincter deficiency. Retropubic colposuspension remains the gold standard, but laparoscopic approaches are considered when concurrent laparoscopic procedures are necessary. Complications of colposuspension include voiding dysfunction, detrusor overactivity, and pelvic organ prolapse. Current guidelines discourage synthetic MUS in patients with poor tissue healing or concurrent urethral surgeries. Postoperative care should focus on monitoring for complications and ensuring the optimal recovery. Long-term success and complications, such as persistent urgency symptoms in mixed urinary incontinence, must be clearly communicated to patients considering surgical intervention. [ABSTRACT FROM AUTHOR]

Key Summary Points: Aim: The aim was to examine factors associated with different subtypes (stress, urgency and mixed) of urinary incontinence among older female hip fracture patients using a cross-sectional design. Findings: Urinary incontinence was frequent, and the most common type was urgency incontinence. Stress incontinence and urgency incontinence were associated with different modifiable risk factors, all of which were associated also with mixed incontinence. Message: Different risk factors converge in mixed urinary incontinence. Comprehensive geriatric assessment is key in the assessment of UI in older hip fracture patients. Purpose: Urinary incontinence (UI) is known to be common among older female hip fracture patients. Little is known about different subtypes of UI among these patients. Our aim was to identify factors associated with subtypes of UI in a cross-sectional design. Methods: 1,675 female patients aged ≥ 65 and treated for their first hip fracture in Seinäjoki Central Hospital, Finland, during 2007–2019, were included in a prospective cohort study. Of these, 1,106 underwent comprehensive geriatric assessment (CGA), including questions on continence, at our geriatric outpatient clinic 6 month post-fracture. A multivariable-adjusted multinomial logistic regression model was used to examine factors associated with UI subtypes. Results: Of the 779 patients included, 360 (46%) were continent and 419 (54%) had UI 6-month post-fracture. Of the women with UI, 117 (28%) had stress UI, 183 (44%) had urgency UI and 119 (28%) had mixed UI, respectively. Mean age of the patients was 82 ± 6,91. In multivariable analysis, depressive mood and poor mobility and functional ability were independently associated with stress UI. Fecal incontinence (FI) and Body Mass Index (BMI) over 28 were independently associated with urgency UI. Mixed UI shared the aforementioned factors with stress and urgency UI and was independently associated with constipation. Conclusions: Mixed UI was associated with most factors, of which depressive mood and impaired mobility and poor functional ability were shared with stress UI, and FI and higher BMI with urgency UI. CGA is key in assessing UI in older hip fracture patients, regardless of subtype. [ABSTRACT FROM AUTHOR]

Purpose:: To compare qualify of life outcomes in women with mixed urinary incontinence (MUI), urge (UUI) or stress (SUI) urinary incontinence after treatment with an anterior vaginal wall suspension (AVWS) to correct urethral hypermobility and concomitant anterior compartment prolapse (ACP). Methods:: Following IRB approval, a prospective long-term database of women who underwent an AVWS for urinary incontinence (UI) with early stage (stage ≤2) ACP was reviewed. Patients completed the Urogenital Distress Inventory short form (UDI-6 SF) and a one question visual analog scale (VAS) of quality of life (QoL) before and after AVWS. Indication for AVWS was based on demonstrable UI, with documented urethral hypermobility and cystocele on standing lateral cystogram comparing rest and straining views. Three groups (MUI, SUI, and UUI) were analyzed based on urge (Question 2) and stress (Question 3) predominant scores at baseline. Results:: From 1997 to 2018, 104 patients met study criteria: 54 with MUI, 30 SUI predominant, and 20 UUI predominant. Total UDI-6 and QoL scores improved significantly from baseline to 1-year post-AVWS and to the last visit (median 3.5 years) in all three groups. Patients with MUI had the most improvement based on UDI-6 total and QoL scores. Conclusions:: Regardless of the nature of baseline UI symptoms, restoring support of the anterior vaginal wall compartment can durably improve UI-specific quality of life scores in the short and long-term.

Background Urinary incontinence often occurs in women aged 40-60 years and contributes to a significant impact on women's physical health and quality of life. Objective To explore the prevalence and influencing factors of urinary incontinence and its impact on quality of life in women aged 40-60 years in Guizhou Province. Methods From June 2022 to January 2023, women aged 40-60 years who underwent health checkups in 10 hospitals in 7 regions of Guizhou Province were selected as the study subjects. A self-designed general data questionnaire was used to collect the basic data of the study subjects, and International Consultation on Incontinence Questionnaire-Female Lower Urinary Tract Symptoms (ICIQ-FLUTS) and Incontinence Quality of Life Measure (I-QoL) were used to determine the severity of urinary incontinence and the level of quality of life of the study subjects, respectively. Different types of incontinence, including stress incontinence, urge incontinence, and mixed incontinence, were determined according to the diagnostic criteria established by the International Continence Society (ICS). Multivariate Logistic regression analysis was used to explore the influencing factors of urinary incontinence, and explore the effects of different types and severity levels of urinary incontinence on patients' quality of life. Results A total of 3 000 questionnaires were distributed, and 2 966 valid questionnaires were collected, with a valid recovery rate of 98.9%. The prevalence of urinary incontinence among the 2 966 study subjects was 33.4% (991/2 966), including 20.1% (596/2 966) for stress incontinence, 2.0% (58/2 966) for urge incontinence, and 11.4% (337/2 966) for mixed incontinence. Multivariate Logistic regression analysis showed that physical exercise, menstrual status, parity, history of pelvic organ prolapse, perineal laceration, and lateral episiotomy were the influencing factors of stress incontinence (P

Objective: Extracorporeal electromagnetic stimulation (ExMS) has been used widely to treat Urinary Incontinance (UI). We aim to analyze the subjective and objective outcomes of ExMS treatment and evaluate factors that could predict satisfaction. Material and Method: Patients who underwent ExMS treatment for UI were evaluated. ExMS was performed twice weekly with 20-minute sessions for six-eight weeks. Subjective satisfaction and objective improvement were evaluated before and three months after treatment with a bladder diary, pad test, and pelvic floor muscle strength assessment. King’s Health Questionnaire was used to evaluate quality of life. Result: Eighty-one patients were included. The mean age was 50.4±9.7 (30-76). Fourty four (54.3%) patients suffered from mixed UI, and 19 (23.5%) and 18 (22.2%) suffered from stress UI and urge UI, respectively. Six patients were cured, 64 (79.1%) were better than before, and the rest noticed no change. After treatment, there were significant improvements in bladder diary, pelvic floor muscle strength, pad test, and King’s Health Questionnaire. There was a significant correlation between the type of UI and satisfaction after treatment; women suffering from stress UI were less satisfied when compared to urge or mixed UI. No correlations were found between treatment satisfaction and age, pretreatment pelvic floor muscle strength, 1-hour pad test, or mean number of leakage and urgency episodes. No complications developed. Conclusion: ExMS is an effective treatment for UI with almost 80% subjective satisfaction. Quality of life, pad test, bladder diary, and pelvic floor muscle strength were improved significantly. The UI type (urge or mixed UI) was a significant predictive factor for treatment satisfaction. [ABSTRACT FROM AUTHOR]

Introduction and Hypothesis: The objective was to investigate how weight change across and after the childbearing years was associated with urinary incontinence (UI) in midlife. Methods: Data were obtained from 35,645 women responding to the Maternal Follow-up questionnaire in the Danish National Birth Cohort in 2013–2014. Outcome was self-reported UI and its subtypes. Exposures were changes in body mass index (BMI) across and after the childbearing years. Adjusted odds ratios were estimated using logistic regression. Results: At follow-up, the mean age was 44 years and 32% experienced UI. Compared with stable weight, weight gain across the childbearing years of > 1 to 3, > 3 to 5 or > 5 BMI units increased the odds of any UI by 15%, 27%, and 41% respectively. For mixed UI, the odds increased by 23%, 41%, and 68% in these groups. Weight gain after childbearing showed the same pattern, but with a higher increase in the odds of mixed UI (25%, 60%, and 95% in the respective groups). Women with any weight loss during this period had 9% lower odds of any UI than women with a stable weight. Conclusions: Weight gain across and after childbearing increased the risk of UI in midlife, especially the subtype mixed UI. Weight loss after childbearing decreased the risk. [ABSTRACT FROM AUTHOR]

Aim:: We aimed to assess the mid- to long-term outcome of Polyacrylamide Hydrogel urethral injections as a treatment for women with stress urinary incontinence (SUI), who are not eligible for treatment with midurethral slings. Methods:: We performed a single-arm, patient cohort study using the subjective improvement rate as primary outcome, defined as an answer “(very) much better” on the Patient Global Impression of Improvement. Secondary outcomes were the subjective cure rate (a negative answer to the Urogenital Distress Inventory stress subscale question 4), patient satisfaction (Visual Analogue Scale of ≥ 8.0), complication rate, the amount of Hydrogel injected, the number of reinjections and to what extent patients would recommend this treatment. Results:: A total of 357 women with pure SUI, or mixed urinary incontinence with predominant SUI were included. Adverse events were retrieved from their patient records and all received a questionnaire, which was completed and returned by 153 (42.9%) women. After a median follow-up of two and a half years, the subjective improvement rate was 52.1%. The subjective cure rate was 30.9%. A satisfaction score of ≥ 8.0 was achieved in 48.6% of the patient group. Minor adverse events due to the procedure were reported in 21% of patients. No serious adverse events were noted. Conclusions:: This study demonstrates that Polyacrylamide Hydrogel, even after a mid- to long-term follow-up, is a valuable treatment option for women with SUI, who are ineligible for midurethral sling surgery. No serious adverse events related to the procedure were reported during the follow-up period.

BackgroundThe urogenital microbiome is associated with urgency and mixed urinary incontinence symptoms and differential treatment responses to pharmacotherapy for urgency urinary incontinence.ObjectiveThis study aimed to describe whether the preoperative urinary and vaginal microbiomes were associated with surgical treatment responses at 12 months after a midurethral sling operation in women with mixed urinary incontinence.Study designThis cohort study compared the preoperative microbiome compositions of urine and vaginal samples from a subset of women undergoing a midurethral sling operation in the Effects of Surgical Treatment Enhanced With Exercise for Mixed Urinary Incontinence trial (NCT01959347) and compared the microbiota in women who were surgical responders vs surgical nonresponders. Twelve-month objective response was defined as a ≥70% reduction from baseline urinary incontinence episodes on a 3-day diary. Subjective response was defined as a change from baseline in the Urogenital Distress Inventory scores. Bacterial abundance and beta diversity were assessed using 16S ribosomal RNA sequencing. The primary differential abundance analysis described predominant bacterial operational taxonomic units associated with responders vs nonresponders using unadjusted and age-adjusted linear models.ResultsObjective nonresponders (n=28) compared with responders (n=72) were older (58.5±10.7 vs 51.6±10.2 years) and more likely postmenopausal without hormone use (odds ratio, 6.4; 95% confidence interval, 1.8-22.6). Vaginal and urinary microbiota beta diversities were associated with age (P

Introduction and hypothesis: Prior studies demonstrate mixed results on the impact of obesity on the success of midurethral slings (MUS), with little known about how postoperative weight change affects outcomes. We aimed to examine the effect of postoperative weight change on outcomes 12 months after MUS for stress urinary incontinence (SUI). Methods: This secondary analysis utilized data from two multicenter randomized trials of women undergoing MUS placement. Subjects were categorized into cohorts based on change in body weight at 12 months postoperatively: weight gain (≥5% increase); weight loss (≥5% decrease), and weight stable (<5% change). The primary outcome was SUI cure (no SUI episodes in a 3-day bladder diary). Patients with mixed urinary incontinence (MUI) were analyzed for changes in daily average urge incontinence (UUI) episodes in a 3-day diary. Penalized logistic regression assessed the impact of demographic and perioperative variables on the primary outcome. Results: Of the 918 women included, 635 (70%) were weight stable, 144 (15%) had weight gain, and 139 (15%) had weight loss. Patients in the weight loss cohort had a higher smoking rate and a higher baseline body mass index (SD 0.29, 2.7 respectively). All cohorts experienced high SUI cure rates ranging from 77 to 81%, with no significant difference in SUI cure between cohorts (p = 0.607). Of 372 subjects with MUI, the weight loss cohort had significantly greater improvement in UUI episodes. Conclusions: Weight change at 12 months postoperatively did not significantly alter efficacy of MUS for treatment of SUI. Patients with MUI who lost ≥5% body weight had significantly greater improvement in UUI episodes. [ABSTRACT FROM AUTHOR]

BackgroundAlthough the vaginal and urinary microbiomes have been increasingly well-characterized in health and disease, few have described the relationship between these neighboring environments. Elucidating this relationship has implications for understanding how manipulation of the vaginal microbiome may affect the urinary microbiome and treatment of common urinary conditions.ObjectiveTo describe the relationship between urinary and vaginal microbiomes using 16S rRNA gene sequencing. We hypothesized that the composition of the urinary and vaginal microbiomes would be significantly associated, with similarities in predominant taxa.Study designThis multicenter study collected vaginal swabs and catheterized urine samples from 186 women with mixed urinary incontinence enrolled in a parent study and 84 similarly aged controls. Investigators decided a priori that if vaginal and/or urinary microbiomes differed between continent and incontinent women, the groups would be analyzed separately; if similar, samples from continent and incontinent women would be pooled and analyzed together. A central laboratory sequenced variable regions 1-3 (v1-3) and characterized bacteria to the genus level. Operational taxonomic unit abundance was described for paired vaginal and urine samples. Pearson's correlation characterized the relationship between individual operational taxonomic units of paired samples. Canonical correlation analysis evaluated the association between clinical variables (including mixed urinary incontinence and control status) and vaginal and urinary operational taxonomic units, using the Canonical correlation analysis function in the Vegan package (R version 3.5). Linear discriminant analysis effect size was used to find taxa that discriminated between vaginal and urinary samples.ResultsUrinary and vaginal samples were collected from 212 women (mean age 53±11 years) and results from 197 paired samples were available for analysis. As operational taxonomic units in mixed urinary incontinence and control samples were related in canonical correlation analysis and since taxa did not discriminate between mixed urinary incontinence or controls in either vagina or urine, mixed urinary incontinence and control samples were pooled for further analysis. Canonical correlation analysis of vaginal and urinary samples indicated that that 60 of the 100 most abundant operational taxonomic units in the samples largely overlapped. Lactobacillus was the most abundant genus in both urine and vagina (contributing on average 53% to an individual's urine sample and 64% to an individual's vaginal sample) (Pearson correlation r=0.53). Although less abundant than Lactobacillus, other bacteria with high Pearson correlation coefficients also commonly found in vagina and urine included: Gardnerella (r=0.70), Prevotella (r=0.64), and Ureaplasma (r=0.50). Linear discriminant analysis effect size analysis identified Tepidimonas and Flavobacterium as bacteria that distinguished the urinary environment for both mixed urinary incontinence and controls as these bacteria were absent in the vagina (Tepidimonas effect size 2.38, P

Abstract Background Urinary incontinence (UI) is one of the most common symptoms during menopause, leading to a decreased quality of life and limited social activities. This study aimed to determine the prevalence and severity of urinary incontinence and associated risk factors in postmenopausal women. Methods It was a cross-sectional study using cluster sampling on 433 postmenopausal women in Tabriz-Iran, 2021–2022. Data were collected using questionnaires of socio-demographic characteristics, Questionnaire for Urinary Incontinence Diagnosis (QUID), and International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UISF). Multivariate logistic regression was used to determine factors related to urinary incontinence. Results The overall prevalence of urinary incontinence was 39.5%; 20.6% stress urinary incontinence (SUI), 10.4% urgency urinary incontinence (UUI), and 8.5% mixed urinary incontinence (MUI). Multivariate logistic regression analysis showed that the prevalence of SUI (aOR 0.38; 95% CI 0.18–0.77) and UUI (aOR 0.38; 95% CI 0.15–0.94) was significantly lower in women with three childbirths than the ones with fewer childbirths. Also, the odds of UUI increased significantly in women at the 50–55 age range (aOR 3.88; 95% CI 1.16–12.93) than those less than 50 years. Conclusion Due to the high prevalence of urinary incontinence in postmenopausal women, caregivers should screen for early diagnosis and appropriate treatment of urinary incontinence to prevent its destructive impact on the quality of life.

Objectives: The aim of this study was to compare the efficacy of the transobturator tape (TOT) procedure combined with solifenacin (TOT‐S) or prasterone (TOT‐P) in postmenopausal women affected by mixed urinary incontinence (MUI) with a predominant stress urinary incontinence component. Methods: This is a retrospective analysis including 112 patients: 60 patients of the TOT‐S group and 52 patients of the TOT‐P group. Physical examination, 3‐day voiding diary, urodynamic tests, and Vaginal Health Index (VHI) were compared at the beginning of the analysis and after 12 weeks of follow‐up (FU). Specific questionnaires were administered to indagate the impact on women's quality of life and sexual function. Results: After 12 weeks of FU, the detrusor's peak flow pressure was significantly different between the two groups (p =.02). Detrusor overactivity decreased only in the TOT‐P group (p =.05). At the end of FU, 58 patients (96.7%) of the TOT‐S group and 50 patients (96.2%) of the TOT‐P group were dry at the stress test. A significative group difference was observed in urge urinary incontinence (24 h) (p =.01) but not in the mean number of voids (24 h) and urgent micturition events (24 h). VHI improved only in the TOT‐P group (12.57 ± 3.80 vs. 19.75 ± 4.13, p <.0001). The questionnaires and Patient Global Index of Improvement (PGI‐I) scores showed comparable improvements, while the Female Sexual Function Index improved especially in the TOT‐P group (p <.001). Conclusions: In postmenopausal women with MUI, TOT‐P demonstrated the same effectiveness as TOT‐S in reducing urinary symptoms. In addition, TOT‐P increased VHI and sexual function scores compared with TOT‐S. [ABSTRACT FROM AUTHOR]

Urinary incontinence, or the complaint of involuntary loss of urine, is a debilitating condition of the lower urinary tract with a potentially significant impact on a patient's physical and mental wellbeing and on their functioning and place in society. Due to the high prevalence of this disorder, the economic burden on healthcare systems worldwide is enormous. Urinary incontinence has a high prevalence in women, but men can be affected as well after a radical prostatectomy or when suffering from chronic urinary retention. Stress, urgency and mixed urinary in-continence are the most common types of urinary incontinence, but other types exist as well. The pathophysiological mechanisms behind these different types of urinary incontinence have been studied extensively. New insights allow for the development of improved diagnostic and therapeutic strategies and ultimately in the reduction of the potentially devastating impact of urinary incontinence on an individual patient's quality of life. In this review, we explore the current theories on the mechanisms behind urinary incontinence. [ABSTRACT FROM AUTHOR]

Increased urinary incontinence is one of the most common changes during menopause. This study aimed to investigate the effect of Nigella sativa L. seed oil on urinary incontinence and quality of life (QoL) (primary outcomes) and sexual function (secondary outcome) in menopausal women. In this triple‐blind randomized controlled trial, 60 women in Tabriz‐Iran were equally allocated into two treatment and control groups using block randomization. The women applied 2–3 drops of Nigella sativa L. seed oil or placebo on their stomachs below the novel twice a day for 8 weeks. The data collection instruments were completed at baseline and just after the intervention. After intervention, the mean rank score of mixed urinary incontinence was significantly lower (p =.04) and the mean score of the incontinence‐QoL was significantly higher (mean difference 12.63, 95% CI 2.33 to 22.93; p =.017) in the treatment group than the control group. However, there were no significant differences in stress incontinence, urge incontinence, sexual function, and menopause‐specific QoL of women between the groups (p >.05). The results indicated the positive effect of the Nigella sativa L. seed oil on mixed incontinence and incontinence‐QoL; nevertheless, to make a certain conclusion, further studies are required. [ABSTRACT FROM AUTHOR]

Background: Stress urinary incontinence is a frequent urological disease in women; it has a great influence on an individual’s wellbeing and places a significant economic strain on any health service. The placement of urodynamic diagnostic tests in the evaluation route is an important clinical research concern in this field. Objective: to find out whether the duration of stress urinary incontinence is associated with the finding of bladder outlet obstruction in urodynamic study or not. Subjects and Methods: A descriptive study. With enrolled female patients had symptomatic Stress urinary incontinence as their primary complain. All the included patients were assessed thoroughly by history taking and physical examination and relevant clinical tests and investigation in addition to urodynamic evaluation consisted of multi-channel urodynamics measuring abdominal, vesical and detrusor pressures simultaneously. Results: 140 females were suffering from stress incontinence. Urodynamic study showed maximum urine flow rate (Q max) mean of (20.45±9.86) ml/second, the maximum post void volume was 500ml with 36.89ml was the mean of post void residual volume, and 90.83cm water was the mean of urethral occlusion pressure. The mean of duration have positive relationship with age category but without statically significant. Ninety-eight patients have Q max flow more than 25ml/sec with mean duration 6.04 without any statically significant (p=0.872). 37 patients were having >0 ml post void volume with mean duration more than other patients that didn’t have post void volume but without statically significant (p=0.257). All patients with urethral pressure less than 120 cm had long duration mean than others but without statically significant (p=0.335). also, no statistical significance association between mean of duration and sphincter pelvic floor electromyogram (EMG). Conclusion: there was no catechistically significant relationship between the urodynamic findings and the duration neither of stress urinary incontinence nor between the urodynamic findings and the age of the patients.

Study design:: Retrospective Objectives:: To evaluate the mid-term urodynamic and clinical efficacy of mid-urethral synthetic sling (MUS) in females with neurogenic stress urinary incontinence (N-SUI) or neurogenic mixed urinary incontinence (N-MUI). Materials and methods:: Between January and April 2021, we conducted a retrospective review of all adult neurological women with clinically and urodynamically proven N-SUI or N-MUI who were treated with retropubic (TVT) or transobturator (TOT) tension free vaginal tape. The outcomes were recorded in a database over a 14-year period.The primary objective outcome measure was the absence of any N-SUI episodes at 3 days Bladder Diary (BD). A Patient Global Impression of Improvement (PGI-I) score ≤ 2 was a secondary endpoint for subjective success. Objective failure was defined as the detection of stress urinary incontinence during follow-up urodynamics. Results:: Twenty-three women out of 65 were included. Mean follow-up was 72.2 ± 45.6 months. TVT was placed in 17/23 patients (74%) who were previously managed by intermittent catheters (IC) and TOT in those 6/23 women (26%) who spontaneously voided at baseline.Dryness at 3 days BD was observed in 12/23 patients (52%). Twenty patients (86%) reported subjective benefits (mean PGI-I 1.4 ± 0.62), of whom eleven (55%) were extremely satisfied (PGI-I = 1).Objective failure was documented in 2/23 women (8%) after surgery. Two patients shifted from IC to indwelling catheter during follow-up (respectively 6 and 8 years after surgery). De novo neurogenic detrusor overactivity was observed in two women at 3 months follow-up. No statistical differences were observed in cystometric parameters comparing baseline to follow-up. Conclusion:: To the best of our knowledge, this is the first study confirming the clinical efficacy and urodynamic safety over a 5-year follow-up, for N-MUI as well. According to our results both TOT and TVT can be used to treat women with N-SUI with or without concomitant NDO. The choice between the two procedures depended on baseline bladder management.

Introduction and hypothesis: The efficacy of mid-urethral sling (MUS) surgery in older women and women with a significant disease burden is limited. We aimed to determine the influence of chronological age and physical status (assessed by the American Society of Anesthesiologists Physical Status, ASA) classification on outcomes. Methods: Cure rate, change in frequency of lower urinary tract symptoms, satisfaction, impact, and adverse events after MUS surgery were assessed in 5200 women aged 55–94 years with MUS surgery (2010–2017). Data were analysed by multivariate logistic regression and Mantel-Haenszel chi-square statistics. Results: The cure rate was 64.2% (95% CI, 60.0–68.4) in the ≥ 75-year cohort compared to 88.5% (95% CI, 87.1–89.8) in the 55–64-year cohort (trend p < 0.0001). The estimated probability of cure, improvement, and satisfaction with the procedure decreased by aOR10yr = 0.51 for cure to aOR10yr = 0.59 for satisfaction (all p < 0.0001). Women with a significant health burden (ASA class 3–4) had lower cure rates and satisfaction than those without (65.5% vs. 83.7%, p < 0.0001 and 65.7% vs. 80.6%, p < 0.0001). Older age was more likely to be associated with de novo urgency (p = 0.0022) and nocturia ≥ 2 (p < 0.0001). Adverse events, readmission, and 30-day mortality rates were low. Women, irrespective of age, were equally satisfied if they experienced a decrease of at least one step in leakage frequency. Conclusions: Even if MUS surgery in older women and those with ASA class 3–4 was associated with a lower cure rate and less satisfactory outcome, a majority were satisfied provided they experienced a reduction of incontinence episodes. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: Mixed urinary incontinence (MUI) is a common yet understudied condition. It remains a therapeutic challenge, with the presence of both stress urinary incontinence (SUI) and urgency urinary incontinence (UUI). There is limited information on the optimal management for women with urodynamic MUI (urodynamic stress incontinence and detrusor overactivity). We assessed the treatment outcome of pelvic floor muscle training (PFMT), medical treatment and surgery for women who were diagnosed with urodynamic MUI. Methods: A prospective observational study was carried out on women with urodynamic MUI from 2010 to 2018. All women underwent clinical assessment and standardised urodynamic evaluation. All women received PFMT from a specialised continence advisor as initial management. Antimuscarinics and/or continence surgery were considered according to the woman's response and symptoms after PFMT. Subjective outcome after each treatment modality was analysed. Results: A total of 198 women were included for analysis. All women received PFMT, 104 (52.5%) showing improvement in urinary incontinence. Eighty-seven (43.9%) women were offered antimuscarinics, of whom 58 (29.3%) showed subjective improvement in both SUI and UUI, and 10 (5%) reported a reduction in UUI but persistent SUI. A total of 55 (27.7%) women received surgical treatment, with 20 receiving continence procedures. Sixteen out of twenty (80%) of them reported improvement in both SUI and UUI. None reported worsening of urgency or UUI. Overall, across all treatment modalities, 73.8% of women showed improvement in both SUI and UUI. Conclusion: Future analyses can help to inform which patients will have a higher success rate after each treatment modality and help focus treatment effort on those with a high risk of persistent symptoms. This will provide relevant data in counselling women, giving reasonable expectations and directing the management of women with urodynamic MUI. [ABSTRACT FROM AUTHOR]

Objectives: We aimed to investigate success rates and predictive factors for midurethral slings (MUS) in women with mixed urinary incontinence (MUI). Methods: Women with MUI (urodynamically diagnosed detrusor overactivity and stress urinary incontinence) treated with MUS between 2013 and 2020 were retrospectively investigated. Prior to MUS, all participants completed bladder diary and questionnaires and underwent a urodynamic study. Six months after surgery, patients were evaluated for lower urinary tract symptoms with pelvic examination, pad test, and the 8‐item Overactive Bladder Questionnaire (OAB‐V8) and the International Consultation on Incontinence Questionnaire‐Short‐Form (ICIQ‐SF). Success rates after MUS were determined separately according to the predominant component of MUI. In addition, multivariable logistic regression analysis was used to determine the most important independent variables affecting the surgical outcome. Results: There were 117 participants. The overall MUI cure rate was 73.5%, but surgical success in the presence of postoperative urgency was 60.7%. Moreover, MUS success rate was 84.8% in those with preoperative stress‐dominant MUI. However, the success rates for equally and urgency‐dominant MUI were both 29.4%. Preoperative OAB‐V8 score, symptom duration >9.5 years, and preoperative anticholinergic medication were risk factors for persistent urgency and urgency urinary incontinence (UUI) postoperatively (p <.05). In addition, diabetes mellitus (DM) for persistent urgency and voiding frequency (daily) for persistent UUI were predictive factors (p <.05). Conclusions: MUS may be offered to women with stress‐dominant MUI. However, postoperative urgency might change a patient's perception of treatment despite successful incontinence treatment. MUS does not appear to be a good option when MUI patients have a high OAB‐V8 score, symptom duration >9.5 years, DM, or use of anticholinergic medication preoperatively. [ABSTRACT FROM AUTHOR]

Background: Urinary incontinence (UI) is one of the most common symptoms during menopause, leading to a decreased quality of life and limited social activities. This study aimed to determine the prevalence and severity of urinary incontinence and associated risk factors in postmenopausal women. Methods: It was a cross-sectional study using cluster sampling on 433 postmenopausal women in Tabriz-Iran, 2021–2022. Data were collected using questionnaires of socio-demographic characteristics, Questionnaire for Urinary Incontinence Diagnosis (QUID), and International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UISF). Multivariate logistic regression was used to determine factors related to urinary incontinence. Results: The overall prevalence of urinary incontinence was 39.5%; 20.6% stress urinary incontinence (SUI), 10.4% urgency urinary incontinence (UUI), and 8.5% mixed urinary incontinence (MUI). Multivariate logistic regression analysis showed that the prevalence of SUI (aOR 0.38; 95% CI 0.18–0.77) and UUI (aOR 0.38; 95% CI 0.15–0.94) was significantly lower in women with three childbirths than the ones with fewer childbirths. Also, the odds of UUI increased significantly in women at the 50–55 age range (aOR 3.88; 95% CI 1.16–12.93) than those less than 50 years. Conclusion: Due to the high prevalence of urinary incontinence in postmenopausal women, caregivers should screen for early diagnosis and appropriate treatment of urinary incontinence to prevent its destructive impact on the quality of life. [ABSTRACT FROM AUTHOR]

The aim of this debate article is to discuss whether effective treatments are available for mixed urinary incontinence (MUI). Because patients with MUI have both stress and urgency urinary incontinence (SUI and UUI) episodes and current treatment guidelines currently recommend treating the predominant symptom first, this article presents standard and emerging treatments for both SUI and UUI before discussing how well these treatments meet the medical needs of patients with MUI. Standard treatments presented include noninvasive options such as lifestyle changes and pelvic floor exercises, pharmacological agents, and surgery. Treatment of all three types of urinary incontinence (UI) is usually initiated with noninvasive options, after which treatment options diverge based on UI subtype. Multiple pharmacological agents have been developed for the treatment of UUI and overactive bladder, whereas surgery remains the standard option for SUI and stress‐predominant MUI. The divide between UUI and SUI options seems to be propagated in emerging treatments, with most novel pharmacological agents still targeting UUI and even having SUI and stress‐predominant MUI as exclusion criteria for participation in clinical trials. Considering that current treatment options focus almost exclusively on treating the predominant symptom of MUI and that emerging pharmacological treatments exclude patients with stress‐predominant MUI during the development phase, effective treatments for MUI are lacking both in standard and emerging practice. Ideally, agents with dual mechanisms of action could provide symptom benefit for both the stress and urgency components of MUI. [ABSTRACT FROM AUTHOR]

Introduction. Mixed urinary incontinence is believed to be more difficult to treat than stress urinary incontinence and overactive bladder (OAB) alone. However, the mixed form occurs in one in three women with complaints of incontinence. Therefore, the evaluation of the effectiveness of the transobturator suburethral sling in patients with a mixed form of urinary incontinence is a topical issue.Objective. To evaluate the efficacy of the transobturator suburethral sling in patients with mixed urinary incontinence.Materials and methods. The cohort study enrolled 106 patients with a mixed form of urinary incontinence. Validated questionnaires (Overactive bladder questionnaire/OABq, Urinary Distress Inventory, Short Form/UDI-6) were used to assess subjective data. Secondary endpoint – objective data of comprehensive urodynamic study 2 – 12 months after transobturator suburethral sling implantation: presence of phase, terminal, constrictor-induced detrusor overactivity (DOA).Results. According to the preoperative evaluation of complaints on validated questionnaires, the mean UDI-6 score was 52.2 ± 16.3 points, OABq was 15.4 ± 5.4 points. After surgery, there was a decrease in the UDI-6 questionnaire scores to 19.4 ± 18.4 scores and OABq to 9.6 ± 4.1 scores, the difference for both of which was statistically significant (p < 0.001). Terminal DOA was sighted in 44 (41.5%) preoperative patients and 33 (31.1%) postoperative patients (p = 0.153). Stress-induced DOA was observed in 27 (25.5%) before and 6 (5.7%) after surgery (p < 0.001), respectively. Seventy-two (67.9%) patients reported satisfaction with the surgery and willingness to recommend it to their friends. For 26 (24.5%) patients, the surgery had no significant effect on quality of life. Eight (7.5%) patients noted a worsening of symptoms after treatment. No effect of sling installation on the course of OAB was found.Conclusion. The placement of a synthetic suburethral sling has improved the quality of life in many patients with a mixed form of urinary incontinence.

INTRODUCTION & HYPOTHESIS:Previous studies have suggested that women with urinary incontinence have an altered urinary microbiome. We hypothesized that the microbiome in women with mixed urinary incontinence (MUI) differed from controls and tested this hypothesis using bacterial gene sequencing techniques. METHODS:This multicenter study compared the urinary microbiome in women with MUI and similarly aged controls. Catheterized urine samples were obtained; v4-6 regions of the 16S rRNA gene were sequenced to identify bacteria. Bacterial predominance (> 50% of an individual's genera) was compared between MUI and controls. Bacterial sequences were categorized into "community types" using Dirichlet multinomial mixture (DMM) methods. Generalized linear mixed models predicted MUI/control status based on clinical characteristics and community type. Post-hoc analyses were performed in women < 51 and ≥ 51 years. Sample size estimates required 200 samples to detect a 20% difference in Lactobacillus predominance with P

Objectives: The objective of this study is to determine patients' satisfaction and quality of life after trans-obturator tape surgery in the setting of mixed urinary incontinence with stress urinary incontinence dominance. Materials and Methods: The patients who had undergone surgery of trans-obturator tape within last 5 years in our clinic were included. All patients had urodynamic evaluations preoperatively. We used incontinence impact questionnare-7 and urogenital distress inventory-6 questionnary forms. Patients were only asked for one-word comment on their satisfaction with the operation: "Satisfied" or "unsatisfied". Also we used visual analog scale 0 to 10 for their satisfaction (happy or unhappy) for trans-obturator tape operation. Results: Thirty-three women included in our study. Median follow-up was 35 months. 6% of them had early postvoiding residual volume of 50 to 100 mL. None reported to have stress urinary incontinence as preoperatively during follow-up. 60% of them were happy/satisfied for having trans-obturator tape operation. This group's median visual analog scale score was 10.40% of them were unhappy/unsatisfied for having transobturator tape operation. This group's median visual analog scale score was one. Conclusion: Unsatisfied rate is high for trans-obturator tape performed for stress dominant mixed urinary incontinence, though successful surgery. This might be unmet preoperative over-expectations of patients like being dry with surgery for all components mixed urinary incontinence or failure of surgeons to inform well about the surgical outcomes. [ABSTRACT FROM AUTHOR]

Purpose: To review the functional results of the midurethral sling (MUS) in the management of mixed urinary incontinence (MUI) and provide guidance on patient selection and the potential benefits of concomitant treatments., Methods: A literature review from the past 20years was conducted from the PubMed database using the terms "mixed urinary incontinence," associated to "sling," "midurethral sling," "suburethral sling," "mid-urethral sling," "sub-urethral sling," and "tension-free vaginal tape"., Results: The efficacy of the MUS varies considerably depending on the definition of success used. Stress urinary incontinence resolved in 78 to 100% of patients while urge urinary incontinence (UUI) resolved in 57.4 to 82% of patients at short-term follow up. Overall urinary incontinence (UI) resolved in 58% to 85% during this time. A significant proportion of women report a high degree of satisfaction with this treatment. Long-term studies with follow-up period greater than 36months revealed a deterioration of the functional outcomes, especially for UUI. Older women with predominant UUI or detrusor overactivity on urodynamics may be at risk for poorer outcomes. Among concomitant treatments studied, OnabotulinumtoxinA injection, ospemifene, physiotherapy, percutaneous tibial nerve stimulation and surgical bladder denervation appears to offer benefits in improving UI. However, the evidence is currently insufficient to recommend their routine concomitant use., Conclusion: MUS is an effective treatment for MUI. Further research is needed to better understand the potential benefits of concurrent treatments and to develop models that can predict outcomes and assist physicians in shared decision making about how to approach the management of MUI., Competing Interests: Disclosure of interest The authors declare that they have no competing interest., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

Urinary incontinence (UI) is a condition that affects patients of all ages, starting with childhood. There are two peaks in its incidence, i.e., in childhood and another one in patients over 40 years of age, which increases continuously with patient age. It is a condition recognized by the World Health Organization as a set of diseases (International Classification of Diseases, ICD-10), and the International Classification of Functionality recognizes the associated extreme disablement. UI is a major health problem affecting the lives of an estimated 400 million persons worldwide. The global aging of the population will cause rise in the incidence of UI in the future. It is expected that UI itself will become a serious health and social burden for both patients and health service providers. UI can be an isolated problem, or it can be associated and/or aggravated by any associated disorder affecting the nervous system such as myelomeningoceles, Parkinson’s disease or stroke. UI often affects the patient daily life, and it can have repercussions on their physical, financial, social, and emotional well-being. At last, it has a negative influence on their sexual health.

Abstract Background Mixed urinary incontinence (MUI) is a common underreported problem among females; it has a major effect on patients’ quality of life. Treatment may be difficult since a single modality cannot be enough to alleviate both the urge and the stress symptoms. Biofeedback-assisted pelvic floor muscle training (PFMT) has a great role in strengthening the pelvic floor muscles especially when accompanied by electrical stimulation. Neuromodulation is another safe well-tolerated method that may improve symptoms of female voiding dysfunction. There are no previous studies that assessed the efficacy of biofeedback-assisted pelvic floor muscle training versus two different types of peripheral neuromodulation which are transcutaneous posterior tibial nerve stimulation (TPTNS) and anogenital neuromodulation in the treatment of mixed urinary incontinence among women. The aim of this work is to study the effectiveness of biofeedback-assisted pelvic floor muscle training with electrostimulation versus two different methods of peripheral neuromodulation techniques in the treatment of women with MUI. Patients were subjected to history taking, assessment questionnaires (Questionnaire for female Urinary Incontinence Diagnosis (QUID), Australian Pelvic Floor Questionnaire (PFQ), and International Consultation on Incontinence Questionnaire-Urinary Incontinence-Short Form (ICIQ-UI-SF)), clinical examination, and manometric pressure assessment. The patients were allocated randomly into three groups. Group I received biofeedback-assisted pelvic floor muscle training and faradic electrical stimulation, group II received posterior tibial neuromodulation, and group III received anogenital neuromodulation. Results The present study included 68 non-virgin female patients with mixed urinary incontinence. Significant improvement was noticed in the three studied groups on the subjective and objective levels. No statistically significant difference was reported between the studied groups following the different types of intervention. Conclusions Biofeedback-assisted pelvic floor muscle training with electrostimulation is as effective as anogenital neuromodulation and posterior tibial neuromodulation in the treatment of mixed urinary incontinence among females. Trial registration PACTR, PACTR202107816829078 . Registered 29 July 2021 - Retrospectively registered.

The European Association of Urology Non-neurogenic Male Lower Urinary Tract Symptoms Panel has comprehensively reviewed the available literature of male incontinence. This review provides the latest information on the diagnosis and management of stress and urge urinary incontinence in males. Urinary incontinence (UI) is a common condition in elderly men causing a severe worsening of quality of life, and a significant cost for both patients and health systems. To report a practical, evidence-based, guideline on definitions, pathophysiology, diagnostic workup, and treatment options for men with different forms of UI. A comprehensive literature search, limited to studies representing high levels of evidence and published in the English language, was performed. Databases searched included Medline, EMBASE, and the Cochrane Libraries. A level of evidence and a grade of recommendation were assigned. UI can be classified into stress urinary incontinence (SUI), urge urinary incontinence (UUI), and mixed urinary incontinence. A detailed description of the pathophysiology and diagnostic workup has been reported. Simple clinical interventions, behavioural and physical modifications, and pharmacological treatments comprise the initial management for all kinds of UI. Surgery for SUI includes bulking agents, male sling, and compression devices. Surgery for UUI includes bladder wall injection of botulinum toxin A, sacral nerve stimulation, and cystoplasty/urinary diversion. This 2022 European Association of Urology guideline summary provides updated information on definition, pathophysiology, diagnosis, and treatment of male UI. Male urinary incontinence comprises a broad subject area, much of which has been covered for the first time in the literature in a single manuscript. The European Association of Urology Non-neurogenic Male Lower Urinary Tract Symptoms Guideline Panel has released this new guidance, with the aim to provide updated information for urologists to be able to follow diagnostic and therapeutic indications for optimising patient care. [ABSTRACT FROM AUTHOR]

Objective: 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. Methods: 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. Results: 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). Conclusion: 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. [ABSTRACT FROM AUTHOR]

Introduction and hypothesisWe describe the rationale and methods of a study designed to compare vaginal and urinary microbiomes in women with mixed urinary incontinence (MUI) and similarly aged, asymptomatic controls.MethodsThis paper delineates the methodology of a supplementary microbiome study nested in an ongoing randomized controlled trial comparing a standardized perioperative behavioral/pelvic floor exercise intervention plus midurethral sling versus midurethral sling alone for MUI. Women in the parent study had at least "moderate bother" from urgency and stress urinary incontinence symptoms (SUI) on validated questionnaire and confirmed MUI on bladder diary. Controls had no incontinence symptoms. All participants underwent vaginal and urine collection for DNA analysis and conventional urine culture. Standardized protocols were designed, and a central lab received samples for subsequent polymerase chain reaction (PCR) amplification and sequencing of the bacterial16S ribosomal RNA (rRNA) gene. The composition of bacterial communities will be determined by dual amplicon sequencing of variable regions 1-3 and 4-6 from vaginal and urine specimens to compare the microbiome of patients with controls. Sample-size estimates determined that 126 MUI and 84 control participants were sufficient to detect a 20 % difference in predominant urinary genera, with 80 % power and 0.05 significance level.ResultsSpecimen collection commenced January 2015 and finished April 2016. DNA was extracted and stored for subsequent evaluation.ConclusionsMethods papers sharing information regarding development of genitourinary microbiome studies, particularly with control populations, are few. We describe the rigorous methodology developed for a novel urogenital microbiome study in women with MUI.

This study aimed to systematically review objective and subjective success and surgical outcomes of suburethral sling surgery for female patients with stress or mixed urinary incontinence using synthetic vs nonsynthetic material with corresponding surgical approaches (retropubic or transobturator). We systematically searched Medline, Embase, EBM Reviews, ClinicalTrials.gov , and Web of Science Core Collection using standardized Medical Subject Headings (MeSH) without date restrictions (PROSPERO-registered). We double-screened studies and used backward citation chaining. We included peer-reviewed randomized controlled trials and prospective or retrospective comparative studies examining outcomes of retropubic or transobturator synthetic vs nonsynthetic (autologous, allograft, or xenograft) slings for female stress or mixed urinary incontinence, with available English or French full texts. We excluded minislings (single insertion point). We allowed slings for recurrent stress or mixed urinary incontinence, and slings concomitant with prolapse surgery, with at least 6 weeks of postoperative follow-up. We excluded systematic reviews, meta-analyses, review studies, case-control studies, case reports, studies that did not describe surgical approach or material, and studies of combination slings. We evaluated study quality using RoB, the Cochrane risk-of-bias tool for randomized controlled trials, and the Newcastle-Ottawa scale for observational studies. We used pooled relative risk with 95% confidence intervals to estimate the effect of sling material type on each outcome through meta-analysis and meta-regression, as appropriate. We screened 4341 abstracts, assessed 104 full texts, and retained 35 articles (30 separate studies). For retropubic synthetic vs nonsynthetic slings, there was no difference in the number of objectively or subjectively continent patients. The rates of reoperation for stress urinary incontinence and overall were higher with nonautologous retropubic slings than with synthetic slings. Compared with autologous slings, retropubic synthetic slings were associated with higher subjective continence in populations with ≥25% recurrent stress urinary incontinence (relative risk, 1.27; 95% confidence interval, 1.12–1.43). There were no differences in continence between transobturator synthetic and nonsynthetic slings. Subjective satisfaction was better in the transobturator synthetic group than in the autologous sling group (relative risk, 1.42; 95% confidence interval, 1.03–1.94). Synthetic and nonsynthetic slings have comparable objective and subjective success, with synthetic materials generally showing better operative outcomes and fewer complications. [ABSTRACT FROM AUTHOR]