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Background: Female sexual function in pregnancy is an under-investigated topic by care providers. This study aimed to investigate the sexual function and the impact of traditional risk factors for pelvic floor disorders (PFDs) during the third trimester of pregnancy., Methods: This is a secondary analysis of a multicenter cross-sectional study conducted in eight hospitals in Italy and Italian-speaking Switzerland. Women at the third trimester of pregnancy aged 18 years and over completed the Italian-PFQPP questionnaire anonymously., Results: Overall, 927 patients in the third trimester of pregnancy answered the questionnaire. About 29.5% of women reported reduced or absent sexual activity. The less reported symptom was coital incontinence (1.3%), while painful intercourses was the most frequent one (50.3%). Nicotine abuse was associated with traumatic sexual intercourses, impaired vaginal sensibility, and negative impact on sexual life and well-being. Familiarity for pelvic floor disorder resulted as a risk factor for coital incontinence (OR=3.61)., Conclusions: Sexual symptoms, with pain during intercourses being the most widely reported, are extremely common in the third trimester of pregnancy and can greatly affect quality of life. Familiarity for pelvic floor disorders and nicotine abuse resulted as significant risk factors for at least one sexual symptom.

Objective: Urinary incontinence (UI) is an involuntary leakage of urine and affects the social, physical, and psychological aspects of many individuals worldwide. The purpose of our study was to examine the prevalence, quality of life (QoL), severity, and different types of UI in overweight and obese women., Methods: We conducted a cross-sectional study of 1,351 consecutive patients, who were recruited between June 2021 and May 2022., Results: The mean age of the patients was 39.7 ± 14.2 years with less than a half in the 19-35-year age group (46.9%); 65% of the subjects were overweight or obese. The overall prevalence of UI was 61.2%. Overweight and obesity accounted to 70.2% of patients with mild to very severe UI. The risk estimates to have UI were 1.84 in overweight and 5.4 in obese group. The risk estimate for severe and very severe UI was 2.33 in overweight and 10.34 in obese group. When considering all subtypes, 67.9% of women with overweight and obesity had any of the subtypes, urge UI, stress UI, and mixed UI. Overweight and obesity were significantly associated with poor QoL in women with UI (p < 0.0001). Among 36.1% of all patients with poor QoL, 79.9% were overweight and obese., Conclusions: Overweight and obesity are important risk factors of UI affecting daily activity and QOL considerably. As the number of people with obesity is increasing, the prevalence of UI with increased severity is likely to increase in young to mid-aged women. Weight loss should be considered as first-line treatment for this patient population., (© 2023 The Author(s). Published by S. Karger AG, Basel.)

Aim: To identify the risk factors for bruises and fractures from falls in patients with overactive bladder (OAB)., Methods: We evaluated 1136 patients with OAB and aged ≥50 years who visited our hospital. Age, sex, frequency of nocturnal urination, and urinary incontinence type were investigated in the 360 eligible patients. Patients were divided into three groups: those patients without falls (no-fall group), those with fall bruises (bruise group), and those with fall fractures (fracture group). The risk factors for bruises and fractures in patients with OAB were evaluated using the logistic regression analysis. In addition, association between the bruises or fractures from falls and the behavior around urination during the night was investigated., Results: The multivariate logistic regression analysis showed that female sex (odds ratio (OR) 2.888, p  = 0.030) and nocturnal urination frequency ≥3 times/night (OR vs. ≤2 times/night, 2.940; p  = 0.040) were significantly associated with bruises. Nocturnal urination frequency ≥3 times/night (OR vs. ≤2 times/night, 2.835; p  = 0.026) and urge incontinence (OR 3.415, p  = 0.016) were significantly associated with fractures. Behavior around urination during the night was significantly associated with fractures ( p  = 0.009)., Conclusion: In the real-world clinical setting, increasing nocturnal urination frequency is a common risk factor for bruises and fractures. Also, female sex and urge incontinence were the risk factors for bruises and fractures, respectively. OAB patients with urge incontinence would especially require aggressive intervention to prevent fractures during night-time voiding., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2023 Shigero Miyajima et al.)

Background and Objectives : Strategies for overactive bladder syndrome (OAB) management involve, among others, strengthening the bladder outlet to suppress urgency and neuromodulating the sacral roots. Magnetic stimulation (MS) is a technology that involves an extracorporeal device that is able to provide an electromagnetic field specifically designed to interact with pelvic floor neuromuscular tissue. The resulting tissue electrical activity induces contraction of the pelvic muscle and neuromodulation of the S2-S4 sacral roots. Flat Magnetic Stimulation (FMS) is a relevant advancement involving homogeneous electromagnetic fields, which are able to optimize the effect on the entire pelvic area. However, the benefits of this new technology for OAB syndrome are poorly known. Consequently, the aim of our study is to analyze the outcomes and quality of life (QoL) impact of FMS with Dr. Arnold (DEKA, Calenzano, Italy) in women suffering from OAB syndrome associated with urinary incontinence. Materials and Methods : This prospective study included patients with OAB, urge urinary incontinence, and no ongoing OAB treatments. At baseline (T0), the Incontinence Impact Questionnaire (IIQ-7), the Female Sexual Function Index (FSFI-19), and the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) were collected. Patients underwent 8 FMS sessions of 25 min each in one month. At the termination of the therapy (T1), women repeated the ICIQ-UI SF, FSFI-19, and IIQ-7 tools. Moreover, the Patient Global Impression of Improvement (PGI-I) questionnaire was collected to evaluate the cure rate. Results : Our study enrolled a total of 57 consecutive patients. Most women had at least one second- or third-line treatment before FMS, while the remaining naive patients had contraindications to pharmacological treatments. No women reported adverse effects during the treatment. After the treatment, we observed a decrease in the IIQ-7 ( p < 0.001) and ICIQ-UI SF scores ( p < 0.001) and an improvement in sexual function ( p < 0.001) evaluated with FSFI-19. According to PGI-I scores, 42 (73.7%) women referred to some kind of improvement, scoring ≤ 3 points. Specifically, 8.7% of patients considered themselves very much improved, 29.8% much improved, 35.1% minimally improved, and 26.3% found no changes. FMS was effective in treating OAB symptoms without any adverse effects. The mechanism is supposed to be related to suppressing the initiation of micturition. This makes FMS a promising device for treating naive and refractory urge urinary incontinence. Conclusion s: The new FMS represents a promising non-pharmacological option for the treatment of naive and refractory OAB.

Introduction: Intravesical botulinum toxin A (BTX-A) has been long established as treatment for overactive bladder and neurogenic bladder dysfunction. However, most published data are reported among a female cohort. Adverse events such as intermittent self-catheterization (ISC) and urinary tract infections (UTIs) play a large role in discontinuation of therapy. There is currently limited information regarding predictive factors to appropriately counsel male patients., Materials and Methods: We retrospectively collected data on male patients undergoing their first intravesical BTX-A therapy from January 2016 to July 2021 in two high-volume centers. Data included demographics, past medical and surgical history, and urodynamic parameters. Patients were excluded if they had a long-term catheter or ISC before initiation of therapy., Results: A total of 69 men were included in the study with a median age of 66 years. There were 18 patients with neurogenic bladder dysfunction. Thirty men had urge incontinence secondary to radical prostatectomy or bladder outflow surgery. Overall rates of ISC were 43.5%. Predictors for ISC included a baseline postvoid residual (PVR) ≥ 50 mL (odds ratio [OR]: 4.2, 95% confidence interval [CI]: 1.36-13.03, p = 0.01), BTX-A dose >100 units (OR: 4.2, 95% CI: 1.36-13.0, p = 0.01). Stress urinary incontinence was protective against ISC (OR: 0.20, 95% CI: 0.04-1.00, p = 0.049) as well as history of prostatectomy/bladder outflow obstruction (BOO) surgery (OR: 0.16, 95% CI: 0.05-0.47, p < 0.001). A multivariable logistic regression model with these factors yielded a c-statistic of 0.80 (optimism-adjusted = 0.75). An enlarged prostate was the only predictor for UTI among our male cohort (OR: 8.0, 95% CI: 2.03-31.5, p = 0.003)., Conclusions: This is the first study assessing risk factors of adverse events among men following BTX-A injection. High PVR and BTX-A dose of >100U were predictors of requiring ISC after BTX-A. Stress incontinence, previous radical prostatectomy, and BOO surgery were all protective against needing ISC post-BTX-A. An enlarged prostate was associated with development of UTI. These factors can be used to assist in counseling male patients regarding their risk of ISC and UTI., (© 2023 Wiley Periodicals LLC.)

Purpose: The purpose of this guideline is to provide a clinical structure with which to approach the diagnosis, counseling, and treatment of female patients with stress urinary incontinence (SUI)., Materials/methods: The primary source of evidence for the 2017 version of the SUI guideline was the systematic literature review conducted by the ECRI Institute. The initial search spanned literature from January 2005 to December 2015, with an additional updated abstract search through September 2016. The current amendment represents the first update to the 2017 iteration and includes updated literature published through February 2022., Results: This guideline has been amended to reflect changes in and additions to the literature since 2017. The Panel maintained that the differentiation between index and non-index patients remained important. The index patient is a healthy female with minimal or no prolapse who desires surgical therapy for treatment of pure SUI or stress-predominant mixed urinary incontinence. Non-index patients have factors that may affect their treatment options and outcomes, such as high grade prolapse (grade 3 or 4), urgency-predominant mixed incontinence, neurogenic lower urinary tract dysfunction, incomplete bladder emptying, dysfunctional voiding, SUI following anti-incontinence treatment, mesh complications, high body mass index, or advanced age., Conclusion: While gains have been made in the field to support new methods for the diagnosis, treatment, and follow-up of patients with SUI, the field continues to expand. As such, future reviews of this guideline will take place to stay in keeping with the highest levels of patient care.

Background: Obesity is a modifiable risk factor for urinary incontinence, yet few studies have investigated how waist circumference as compared to body mass index (BMI) influences the risk of urinary incontinence., Objective: To estimate how BMI and waist circumference associates with risk of urinary incontinence in midlife and determine which of the two is the strongest predictor of urinary incontinence., Methods: Cohort study among mothers in the Danish National Birth Cohort. Weight and waist circumference were self-reported 7 years after cohort entry. Symptoms of urinary incontinence in midlife were self-reported using the International Consultation on Incontinence Questionnaire Female Lower Urinary Tract Symptoms (ICIQ-FLUTS) and analyzed continuously and as presence or absence of any, stress (SUI), urgency (UUI), and mixed (MUI) urinary incontinence. Linear and log binomial regressions were used to calculate mean differences and risk ratios (RR) with 95% confidence intervals (CI). Restricted cubic splines were generated to explore nonlinear relationships., Results: Among 27 254 women at a mean age of 44.2 years, any urinary incontinence was reported by 32.1%, SUI by 20.9%, UUI by 2.4%, and MUI by 8.6%. For all outcomes, increases in risk were similar with higher BMI and waist circumference. The estimates of association were strongest for MUI (RR 1.10, 95% CI 1.08;1.12 and RR 1.12, 95% CI 1.10;1.14 for half a standard deviation increase in BMI and waist circumference, respectively). While increases in risk of the other outcomes were seen across the entire range of BMI and waist circumference, the risk of SUI rose until BMI 28 kg/m 2 (waist circumference 95 cm), and then fell slightly., Conclusions: Symptoms of urinary incontinence and prevalence of any urinary incontinence, SUI, UUI, and MUI increased with higher BMI and waist circumference. Self-reported BMI and waist circumference were equally predictive of urinary incontinence., (© 2023 The Authors. Neurourology and Urodynamics published by Wiley Periodicals LLC.)

Purpose: Fecal incontinence (FI) is common, but its etiology is complex with large knowledge gaps. Several phenotypes of FI are known, but the phenotype is often not decisive in the chosen therapy. In this study we aimed to assess the association of the clinical characteristics of patients with FI and the various phenotypes, in order to establish a targeted clinical treatment decision tree., Methods: We retrospectively studied the charts of patients with FI, who visited our institute from January 2018 until December 2020. Patients were divided into the following groups: passive fecal loss, urge incontinence, combined fecal incontinence with predominantly passive fecal loss, and combined fecal incontinence with predominantly urge incontinence. We compared the characteristics between the passive and urge incontinence groups, the passive  and combined mainly passive groups, and the urge and combined mainly urge groups., Results: Patients with passive incintinence were older, more often had a flaccid anus with presence of a mucosal prolapse, and had a lower resting pressure on anorectal manometry. Patients with urge incontinence were younger and more often had a history of birth trauma. The combined groups showed characteristics of both of the main types of FI., Conclusion: Differentiating into phenotypes of FI can be clinically meaningful. The patient history and clinical judgement of the consulting specialist, rather than the physical characteristics, seem to be decisive in the categorization. Additional diagnostic testing can be helpful in complicated cases, but should not be used routinely., (© 2023. The Author(s).)

Male Incontinence - An Overview and its Relationship to Benign Prostatic Enlargement Abstract: Male urinary incontinence is a common disease in elderly men and can lead to a significantly reduced quality of life. Reported prevalence of urinary incontinence increases up to 32% in men over 85 years. Risk factors for urinary incontinence are prostate surgery, advanced age, immobility, urinary tract infections, diabetes mellitus, cognitive disorders, and neurological disease. Urinary incontinence is divided into three subtypes: stress urinary incontinence, urge urinary incontinence, and mixed urinary incontinence. Benign prostatic obstruction can lead to a detrusor overactivity and a further urge incontinence. However, iatrogenic injury or a preexisting weakness of the external urinary sphincter are more common and can lead to stress urinary incontinence in men following prostate surgery. A correct treatment can significantly improve symptoms in men suffering from urinary incontinence. Though, every treatment plan must be tailored to the individual patient.

Background: Fibromyalgia (FM) is a rheumatic syndrome that causes musculoskeletal disorders and is associated with several problems that affect quality of life. As the musculoskeletal system is affected, it can have an impact on the pelvic floor muscles, leading to pelvic floor dysfunction (PFD)., Objective: Investigate the occurrence of PFD, such as urinary incontinence (UI) and anal incontinence (AI), sexual problems, and pelvic organ prolapse (POP), in women with FM compared to a control group composed of women without FM; and investigate the association between FM and PFD., Study Design: This was an online cross-sectional survey. Demographic and anthropometric data, the description of PFD (UI, nocturia, AI, genital-pelvic pain/penetration disorder, and POP), and previous obstetric history were collected through a web-based questionnaire. The groups were compared using the independent t-test for quantitative variables and the chi-square test for categorical variables. The association between FM and PFD was tested using logistic regression analysis., Results: A total of 175 women answered the questionnaire (97 with FM and 78 healthy controls). The women with FM reported significantly more UI, mixed urinary incontinence, AI, POP, and vaginismus than the healthy controls (p ≤ 0.05). FM was associated with mixed urinary incontinence (OR: 2.6; 95 % CI: 1.1-6.4; p = 0.04), anal incontinence (OR: 2.9; 95 % CI: 1.3-6.1; p = 0.01), and flatus incontinence (OR: 2.6; 95 % CI: 1.2-5.4; p = 0.01)., Conclusion: The prevalence of PFD was significantly higher in women with FM compared to healthy women. Indeed, the women with FM were 2.6-fold to 2.9-fold more likely to report mixed urinary incontinence, anal and flatus incontinence than those in the control group. The present findings show possible impairment of the pelvic floor musculature in women with FM., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Objective: The aim of the study is to evaluate the incidence of urinary incontinence (UI) and its impact on sexual function among women within 3 years of delivery., Methods: This was a cross-sectional study of 531 participants who gave birth by any method in the past 3 years. Participants were administered the Edinburgh Depression Screening Questionnaire, Generalized Anxiety Disorder-7 questionnaire, the Overactive Bladder Symptom Score questionnaire, Incontinence Impact Questionnaire, Sexual Function Questionnaire's Medical Impact Scale, and Decreased Sexual Desire Screener. The primary outcome of interest was the report of any sexual dysfunction and urinary symptoms., Results: There were 531 total participants of 600 who completed the survey in its entirety. The mean age of the cohort was 29.6 ± 7.1 years, the majority were non-Hispanic White (76.6%). It was found that 55% of the women (n = 292) reported postpartum UI (73% [n = 213] stress incontinence, 26.7% [n = 78] urgency incontinence, and 0.003% [n = 1] mixed incontinence). Sexual dysfunction was more likely to be reported in participants with UI compared with those without UI (34.2% vs 17.8%, P < 0.001). Urinary incontinence was found to be associated with any form of sexual dysfunction after adjustment for confounders (adjusted odds ratio [aOR], 1.63; 95% confidence interval [CI], 1.07-2.14). Additional variables that were correlated with sexual dysfunction were perceived difficulty healing after any delivery injury (aOR, 4.79; 95% CI, 1.11-20.72), current breastfeeding (aOR, 3.29; 95% CI, 1.26-8.59), and an increasing Generalized Anxiety Disorder-7 score (aOR, 1.10 per 1-point increase; 95% CI, 1.05-1.15)., Conclusion: Urinary incontinence is independently associated with sexual dysfunction and should be systematically evaluated during postpartum care., Competing Interests: The authors have declared they have no conflicts of interest., (Copyright © 2022 American Urogynecologic Society. All rights reserved.)

Objective: Urinary tract infection (UTI) is relatively common post-operative complication following midurethral sling placement (MUS), even in cases where intraoperative antibiotic prophylaxis was given. The primary aim of this study was to investigate the non-inferiority of Femistina as compared with Canephron in reducing symptomatic UTI in first six months following surgery., Study Design: A sample size of 144 patients per group was established, to provide at least 90% power to demonstrate the non-inferiority of phytodrug Femistina versus Canephron as a prevention of post-MUS urinary tract infection., Results: Women suffering from stress urinary incontinence and mixed urinary incontinence (MUI) with predominant SUI symptoms as confirmed by urodymamics (n = 320) were randomized in a 1:1 ratio to Femistina (40 mg, oral, twice daily for 20 days) or Canephron (3 × 5 ml taken orally-three times daily for 4 weeks). Both groups were homogenous for age, type of operation (only TOT outside-in) and severity of illness as indicated by ICIQ-SF questionnaire. We found that symptoms of UTI were significantly lower in patients receiving Femistina. During first 6 months after surgery UTI was confirmed in only 10 patients receiving Femistina (6,25%) when compared to 25 (15,63%) subjects receiving Canephron, p < 0.007., Conclusion: Femistina is not inferior to Canephron in preventing lower urinary tract infection after midurethral sling surgery., Competing Interests: Declaration of Competing Interest Tomasz Rechberger – speaker for Astellas, Adamed, Bayer, Bionorica. Investigator for Bayer; Pawel Miotla – speaker for Astellas, Adamed, Bionorica, Gedeon Richter. Investigator for Bayer and Adamed; Ewa Rechberger, Andrzej Wrobel and Beata Kulik-Rechberger – no conflict of interests., (Copyright © 2022. Published by Elsevier B.V.)

Objectives: To assess the change of storage symptoms (SS) and their impact on quality of life in men undergoing thulium:YAG laser enucleation of the prostate (ThuLEP) for benign prostatic hyperplasia (BPH). Materials and Methods: BPH patients requiring surgery were prospectively evaluated (April 2019-October 2020). Inclusion criteria: International Prostate Symptom Score (IPSS) ≥8, maximum urinary flow rate ≤15 mL/s, and urinary retention. Exclusion criteria: previous urethral/prostatic surgery, pelvic irradiation, bladder/prostate cancer, neurogenic bladder, concomitant transurethral surgery, and active urinary tract infection. IPSS, International Continence Society-Overactive Bladder (ICIQ-OAB) and International Continence Society-Overactive Bladder Quality of Life (ICIQ-OABq) scores were gathered before surgery and 1, 3, 6, and 12 months after surgery. Results: In total, 117 men were included. Mean age was 68.0 ± 7.7 years. Mean prostate volume was 86.6 ± 34 cc. Mean IPSS subscore was 8.7 ± 3.1 and 11.7 ± 4.7 for storage and voiding symptoms, respectively. Mean ICIQ-OAB was 29.1 ± 16.8. Mean ICIQ-OABq was 80.3 ± 30.6. Voiding IPSS decreased 72.8% at 1 month, whereas the reduction of storage IPSS was 38.0%. ICIQ-OAB decreased 49.6% at 1 month. ICIQ-OABq showed a 30.0% reduction. One year after surgery, the reduction of voiding IPSS was 94.8%, ICIQ-OAB 85.5%, storage IPSS 76.7%, and ICIQ-OABq 60.5%. Urge incontinence was present in 26.5% of men at 1 month, 15.4% at 3 months, and 4.3% at 6 months. Four (3.4%) patients complained of urge incontinence 12 months after surgery. Conclusion: Both storage and voiding lower urinary tract symptoms significantly decreased after ThuLEP, but storage symptoms showed less reduction with a significant impact on patients' quality of life, particularly during the first 3 months.

Importance: Diabetes is an independent risk factor for urinary incontinence, and its impact on rates of postoperative incontinence after pelvic reconstructive surgery remains unexplored., Objective: The aim of the study was to compare the incidence of postoperative stress urinary incontinence (SUI), urgency urinary incontinence (UUI), and mixed urinary incontinence in patients with diabetes mellitus undergoing surgery for pelvic organ prolapse (POP) with or without SUI surgery., Study Design: This is a secondary analysis of a multicenter retrospective cohort study involving 10 diverse medical centers that identified a cohort of women with diabetes who had prolapse and/or anti-incontinence surgery. We compared rates of postoperative urinary incontinence among patients who had surgery for prolapse and incontinence versus surgery for prolapse only., Results: Three hundred five patients had surgery for prolapse and incontinence, 330 had surgery for prolapse only, and 189 had anti-incontinence surgery only. De novo UUI was higher among those who underwent surgery for POP and SUI compared with surgery for POP alone (26.4% vs 14.1%, P < 0.01). Rates of persistent SUI (21% vs 4.9%, P < 0.01) and mixed urinary incontinence (15.9% vs 2.7%, P < 0.01) were higher for those who underwent prolapse surgery alone versus prolapse and an incontinence procedure. No differences were seen in hemoglobin A1C levels between those who did and did not report postoperative UI., Conclusions: We found that postoperative de novo UUI rates were high among patients with diabetes after pelvic reconstructive surgery, with the incidence being significantly higher for those who had surgery for prolapse and incontinence compared with surgery for prolapse only., Competing Interests: The authors have declared they have no conflicts of interest., (Copyright © 2022 American Urogynecologic Society. All rights reserved.)

Introduction and Hypothesis: Coital incontinence (CI) is an underreported symptom among sexually active women. It has been assumed that incontinence at penetration (CIAP) is due to urodynamic stress incontinence (USI), while coital incontinence at orgasm (CIAO) is thought to be due to detrusor overactivity (DO)., Methods: To evaluate demographic and urodynamic findings associated with coital incontinence (CI) and to confirm the hypotheses 'CIAP is associated with USI' and 'CIAO is associated with DO we performed a retrospective study of 661 sexually active women attending a tertiary clinic between January 2017 and December 2019 for pelvic floor dysfunction. All patients filled in a standardized questionnaire and had a clinical examination and multichannel urodynamic testing. Women were asked if they experienced urine leakage during intercourse and the timing of such leakage., Results: Of 661 sexually active women, one third (n = 220) reported coital incontinence. While 121 (18%) women experienced CIAP, 172 (26%) had CIAO and 76 (11.5%) suffered both. For women with pure USI, the prevalence of CIAP (61.7%) and CIAO (69.5%) was significantly higher than for women with pure DO, where only 12.3% had CIAP and 8.6% had CIAO. Factors significantly associated with CI were body mass index, mid-urethral closure pressure (MUCP) and abdominal leak point pressure (ALPP). When only women with pure USI or DO were included, USI remained associated with CI while DO was not., Conclusions: CI is clearly associated with SUI and USI and is likely to share etio-pathogenetic mechanisms. CI seems to be a manifestation of USI, even when it occurs during orgasm., (© 2021. The International Urogynecological Association.)

Purpose: The aim of this study was to evaluate the effect of an intervention based on and information, motivation, behavioral skills (IMB) model on urinary incontinence symptoms, impact on daily activities, and incontinence-specific quality of life in men with overactive bladder dysfunction (OAB) and urge incontinence., Design: Parallel-group, open-label, randomized-controlled clinical trial., Subjects and Setting: The sample comprised 60 male patients admitted to the urology clinic of a training and research hospital in Ankara, Turkey. Inclusion criteria were adult men older than 18 years and diagnosed with OAB and urge incontinence., Methods: Data were collected from February 2018 to February 2019. Participants were randomized into 2 equal groups. The intervention group (n = 30) received a structured intervention based on the IMB model, and a control group (n = 30) received standard OAB management. The primary outcome was severity of urge incontinence measured by the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF). Secondary outcomes were mean scores on the Urogenital Distress Inventory (UDI-6), Incontinence Impact Questionnaire-7 (IIQ-7), and Urinary Incontinence Information Rating. All outcome measures were evaluated before and 6 months after the training., Results: Following the intervention, mean ICIQ-SF scores were significantly lower in the IMB model group as compared to the control group. Analysis revealed a significant increase in knowledge scores in both groups when baseline scores were compared to postintervention scores (P = .000 for the intervention group and P = .004 for the control group). The intervention group participants also had a higher postintervention scores when compared to control group subjects (P = .000)., Conclusions: A structured behavioral intervention based on the IMB model significantly alleviated the severity of bothersome lower urinary tract symptoms in adult males with OAB and urge incontinence when compared to standard care., (Copyright © 2022 by the Wound, Ostomy and Continence Nurses Society.)

The paper by Karjalainen et al., who reviewed 2,933 pelvic organ prolapse surgeries, showed 75% cure for "bothersome" urge urinary incontinence (UUI), is more than an "Aha" moment; it is an "Emperor has no clothes" moment. Since 1976, a convention of "no surgery" for women with UUI (now overactive bladder, OAB) has become almost an article of faith. Yet, surgical cure of OAB has been known since 1997, when this journal published the first urodynamically controlled study with 20-month data: 86% cure for UUI, 85% for frequency, 80% for nocturia following pubourethral ligament (PUL) and uterosacral ligament (USL) sling repair in 85 women. This study was followed by many other publications over the years recording OAB cure. It is not that even a small fraction of the 600 million women on the planet will now undergo surgery, or that damaged ligaments are the only cause of OAB. However, knowing OAB can be cured opens the door for young creative minds to bring hope and relief to these women non-surgically, as well as surgically., (© 2022. The Author(s).)

Introduction and Hypothesis: The coexistence of urinary incontinence (UI) and depression has been intensively examined in women. This study aimed to investigate the prevalence and some clinical correlates of depression in women with UI., Methods: The National Health and Nutrition Examination Survey (NHANE) 2005-2018 was used in this cross-sectional study, and a total of 7250 UI patients were included. Patientss were defined as having UI if they answered "yes" to the UI screening question. Depression symptoms were measured by Personal Health Questionnaire (PHQ-9)., Results: The age-standardized prevalence of depression in women with UI was 13.7 (95% CI: 12.5-14.9). Multiple logistic regression showed that being younger (age <60 years), widowed, divorced or separated and having lower income, lower education level, more severe incontinence and mixed UI were associated with an increased likelihood of depression., Conclusions: This population-based study suggested that the prevalence of depression in women with UI was high. The main clinical correlates for depression were younger age (<60 years), lower education level, lower income, being widowed, divorced or separated, and having more severe incontinence and mixed UI., (© 2022. The International Urogynecological Association.)

Importance: Symptoms of urinary frequency, urgency, and urinary leakage are characteristic of overactive bladder (OAB) syndrome. However, frequency and urgency symptoms are also present in most patients with interstitial cystitis/bladder pain syndrome (IC/BPS)., Objective: Our objective was to describe the urge incontinence among women with IC/BPS, which may indicate true overlap of OAB and IC/BPS., Study Design: This is a prospective study of women with IC/BPS diagnosed clinically in the Veterans Affairs Health Care system. Patients completed the OAB and Female Genitourinary Pain Index (F-GUPI) questionnaires. Questions from the OAB questionnaire were used to analyze symptoms of urinary urgency and urge incontinence. Pain symptoms, urinary symptoms, and impact on quality of life were assessed based on the F-GUPI. Patient demographics, comorbidities, and symptoms were reviewed., Results: Within the cohort of 144 women with IC/BPS, 100 (69%) had urinary leakage associated with the strong desire to void and were more likely to have incontinence compared with healthy controls (P < 0.001). The IC/BPS group also had higher total and pain scores on the F-GUPI (P < 0.001), but pain scores were not affected by the presence of incontinence (P = 0.478)., Conclusions: The prevalence of OAB symptoms of urinary leakage is high among women with IC/BPS. This may explain the efficacy of OAB medication and third-line therapies in this population., Competing Interests: The authors have declared they have no conflicts of interest., (Copyright © 2022 American Urogynecologic Society. All rights reserved.)

Objective: Urinary incontinence has a profound impact on women's quality of life. Studies have shown that changes in urinary protein levels could be a potential diagnostic biomarker in some urological diseases. The aim of present study is to determine the diagnostic value of nerve growth factor (NGF) in women with mixed urinary incontinence (MUI) as a diagnostic biomarkers of detrusor overactivity (DO)., Methods: Seventy women aged between 20 and 75 years with MUI were enrolled in this prospective study. All participants underwent urodynamic study. Urine NGF levels were measured using an ELISA method. NGF level was compared between groups using Mann-Whitney U test. Receiver Operator Characteristic (ROC) analysis was employed to evaluate the diagnostic performance of urinary NGF., Results: The results showed that the median (min, max) of NGF in patients with DO was significantly higher in comparing to its level in women without DO [184.10 (31, 346.60) pg/ml vs. 151.80 (21, 210.70)], respectively (P = 0.035). Using receiver-operator characteristics analysis, the threshold urinary NGF value of 102.00 pg/ml provided a sensitivity of 88% and specificity of 40% in diagnosing DO, PPV of 39.1%, and NPV of 88.2%, positive likelihood ratio 2.18 and negative likelihood ratio of 0.45 (P = 0.02)., Conclusion: Based on high sensitivity and low specificity, we can conclude that NGF can be a good tool for ruling out the OAB when the test is negative. However, the future investigations are needed to expand the observed correlation in larger groups of women with DO., (© 2021. The Author(s), under exclusive licence to Springer Nature B.V.)

Objective: To determine whether ejaculatory dysfunction (EjD) and post-void dribbling (PVD) after urethroplasty are associated, providing evidence for a common etiology., Methods: We reviewed a prospectively maintained database for first-time, anterior urethroplasties. One item from the Male Sexual Health Questionnaire (MSHQ) assessed EjD: "How would you rate the strength or force of your ejaculation". One item from the Urethral Stricture Surgery Patient-Reported Outcome Measure (USS-PROM) assessed PVD: "How often have you had slight wetting of your pants after you had finished urinating?". The frequency of symptoms was compared after penile vs. bulbar repairs, and anastomotic versus augmentation bulbar repairs. Associations were assessed with chi-square., Results: A total of 728 men were included. Overall, postoperative EjD and PVD were common; 67% and 66%, respectively. There was a significant association between EjD and PVD for the whole cohort (p<0.0001); this association remained significant after penile repairs (p=0.01), bulbar repairs (p<0.0007), and bulbar anastomotic repairs (p=0.002), but not after bulbar augmentation repairs (p=0.052). EjD and PVD occurred at similar rates after penile and bulbar urethroplasty. The rate of EjD was similar after bulbar augmentation and bulbar anastomotic urethroplasties, but PVD was more common after bulbar augmentation (70% vs. 52%) (p = 0.0001)., Conclusion: EjD and PVD after anterior urethroplasty are significantly associated with one another, supporting the theory of a common etiology. High rates after penile repairs argue against a bulbospongiosus muscle damage etiology, and high rates after anastomotic repairs argue against graft sacculation. More work is needed to better understand and prevent symptoms., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Objective: To determine if vitamin D intake is associated with reduced progression of urgency urinary incontinence (UI) in women., Methods: We used the Nurses' Health Study (NHS) I and NHSII cohorts to evaluate the association of vitamin D intake with progression of urgency UI and mixed UI, from mild-moderate to severe symptoms, from 2004 to 2012 (NHS) and 2005-2013 (NHSII). Intake of vitamin D at study baseline was categorized and updated at the start of each 2-4 year follow-up period. Multivariable-adjusted relative risks (RRs) and 95% confidence intervals (95% CI) of progression to severe UI were estimated using Cox proportional hazard models., Results: At baseline, of the 20,560 older women (age range 58-73 years) in NHS I with mild/moderate urgency or mixed UI, 21% reported oral vitamin D intake of at least 800 IU per day. Among 12,573 middle-aged women (age range 42-59) in NHS II with mild/moderate urgency or mixed UI, 17% reported oral vitamin D intake of at least 800 IU daily. From 2004 to 2012, 4853 incident cases of urgency/mixed UI progression were identified among older women. From 2005 to 2013, 1378 incident cases of urgency/mixed UI progression were identified among middle-aged women. After multivariable adjustment, no significant associations between vitamin D intake and incidence of urgency/mixed UI progression were observed in either cohort (RR = 1.10, 95% CI 0.99-1.23 in older women, RR = 0.88, 95% CI 0.71, 1.10 in middle-aged women)., Conclusion: Despite interest in vitamin D as a low-cost strategy to prevent or reduce UI, our findings indicate oral vitamin D may not reduce urgency/mixed UI progression., (Published by Elsevier Inc.)

Over 50% of women with detrusor overactivity (DO), who do not respond to therapy have been shown to have bacteriuria, which may stimulate the release of inflammatory cytokines than can enhance nerve signalling, leading to symptoms of urgency. This study made use of a consecutive series of urine samples collected from women with refractory DO, who participated in a clinical trial of rotating antibiotic therapy. The aim was to determine the effect of bacteriuria and antibiotic treatment on the levels of urinary cytokines, and to correlate the cytokine concentration with patient outcome measures relating to urgency or urge incontinence. The urinary cytokines chosen were IL-1α, IL-1 receptor antagonist, IL-4, IL-6, IL-8, IL-10, CXCL10 (IP-10), MCP-1 and TNF-α. The presence of bacteriuria stimulated a significant increase in the concentrations of IL-1α (P 0.0216), IL-1 receptor antagonist (P 0.0264), IL-6 (P 0.0003), IL-8 (P 0.0043) and CXCL-10 (P 0.009). Antibiotic treatment significantly attenuated the release of IL-1α (P 0.005), IL-6 (P 0.0027), IL-8 (P 0.0001), IL-10 (P 0.049), and CXCL-10 (P 0.042), i.e. the response to the presence of bacteria was less in the antibiotic treated patients. Across the 26 weeks of the trial, antibiotic treatment reduced the concentration of five of the nine cytokines measured (IL-1α, IL-6, IL-8, IL-10 and CXCL-10); this did not reach significance at every time point. In antibiotic treated patients, the urinary concentration of CXCL-10 correlated positively with four of the six measures of urgency. This study has shown that cytokines associated with activation of the innate immune system (e.g. cytokines chemotactic for or activators of macrophages and neutrophils) are reduced by antibiotic therapy in women with refractory DO. Antibiotic therapy is also associated with symptom improvement in these women, therefore the inflammatory response may have a role in the aetiology of refractory DO., Competing Interests: The authors have declared that no competing interests exist.

Background: Fecal urgency is classically associated with diarrhea, but is also common in individuals with normal bowel habits or constipation. Its etiology, particularly in non-diarrhea individuals, is unclear., Methods: We examined data from 368 individuals with and without diarrhea who underwent three-dimensional high-resolution anorectal manometry and balloon expulsion test. All patients completed the Rome III constipation module and the pelvic floor distress inventory (PDFI-20) survey. Patients were considered to have fecal urgency if they reported being bothered "moderately" or "quite a bit" by it in the past 3 months., Results: A total of 103 patients (28.0%) met our definition of fecal urgency. These patients were significantly more likely to meet criteria for irritable bowel syndrome and to report fecal incontinence, urinary incontinence, and diarrhea. Fecal urgency was associated with rectal hypersensitivity in those with diarrhea, but not in those without diarrhea. Fecal urgency was associated with urinary urge incontinence in those without diarrhea, but not those with diarrhea., Conclusions: In patients with diarrhea, fecal urgency is associated with rectal hypersensitivity, whereas in patients without diarrhea, fecal urgency is associated with urinary urge incontinence. This suggests that fecal urgency has different pathophysiological mechanisms in patients with different underlying bowel habits.

Objective: The objective of this study was to determine whether levels of choline (Ch) differ in women with and without overactive bladder (OAB) symptoms., Methods: New patients were evaluated using the overactive bladder symptom score; Medical, Epidemiologic, and Social Aspects of Aging (MESA) urgency incontinence questionnaire; and Impact Questionnaire 7 and provided a urine sample. Patients were stratified into asymptomatic controls, scoring 0 on overactive bladder symptom score and the MESA questionnaire, and patients with OAB and urgency incontinence (OAB-wet). Patients with conditions predisposing to OAB or had a history of OAB treatment were excluded. Choline detection was accomplished using a commercially available kit. Wilcoxon rank sum test and Fisher exact test were used to express differences between groups. Spearman ρ correlation was used to determine the relationship between Ch and questionnaire scores. Logistic regression was used to identify significant variables associated with OAB., Results: Sixty-three women were included in the final analysis. Patients with OAB-wet were older (P = 0.001), more likely to be obese (P = 0.04), had greater apical descent (P = 0.02), were more likely to be postmenopausal (P = 0.01), and were more likely to have stress incontinence (P = 0.005). Choline was 34.8% lower in OAB compared with the controls (P = 0.014). Lower Ch levels were associated with higher MESA (Spearman ρ = -0.311, P = 0.03). After logistic regression, lower Ch (adjusted odds ratio [aOR], 0.97; 95% confidence interval [CI], 0.96-0.98), age (aOR, 1.12; 95% CI, 1.08-1.18), and body mass index (aOR, 1.09; 95% CI, 1.01-1.18) were significantly associated with OAB-wet., Conclusions: Choline levels are significantly decreased in women complaining of OAB with urgency incontinence, and lower levels are associated with higher MESA scores.

Introduction: Urinary incontinence is a severe and common health problem. In this study, we aimed to assess severity of sexual dysfunction and depression in patients with urinary incontinence., Materials and Methods: The study has been conducted between 2015 and 2017. Age, body mass index, accompanying health problems, Over Active Bladder (OAB) symptom score, Type of urinary incontinence, Beck Depression Scale were assessed for all patients. International Index of Erectile Function-5 (IIEF-5) was used for male patients in order to assess sexual dysfunction. Index of Female Sexual Function (IFSF) and Female Sexual Distress Scale (FSDS) were used in female patients in order to assess sexual dysfunction., Results: 33 patients have been included in the study (Male-12: Urge-10/Stress-1/Mixed-1/Female-21: Urge-10/Stress-6/Mixed-5). Mean age of all patients was 47.9 (Male-49.3/Female-47.2). Mean Body Mass Index for all patients was 23.2 (Male-25.9/Female-21.8). Mean OAB score was 24.3 for all patients (Male-27.5: Urge-28.6/Stress-17/Mixed-27/Female-22.5: Urge-24.2/Stress:21.3/Mixed-20.6). Mean Beck Depression Result for all patients was 20.9 (Male-18.5: Urge-20.2/Stress-9/Mixt-11/Female-22.4: Urge-19.1/Stress-20.3/Mixed-31.6). Mean IIEF-5 score for male patients was 39.5 (Urge-41.4/Stress-55/Mixed-5). Mean IFSF score for female patients was 19.9 (Urge-17.9/Stress-21.3/Mixed-22.4) and mean FSDS score for female patients was 22.1 (Urge-22.3/Stress-23.1/Mixed-20.8)., Discussion: Most of the patients that have been included in the study were diagnosed as urge incontinence. When assessing the OAB scores, they were higher in urge incontinence group. Beck depression results showed higher scores in female patients and it was higher in urge group of male patients and mixt group of female patients. Sexual dysfunction rates were found to be higher for both genders., (Copyright © 2018 Asociación Española de Andrología, Medicina Sexual y Reproductiva. Publicado por Elsevier España, S.L.U. All rights reserved.)

Background: Urinary incontinence subtypes often differ by symptom severity and treatment profiles; in particular, mixed urinary incontinence is generally associated with worse symptoms and less successful treatment. Yet, limited information exists on the natural history of different urinary incontinence subtypes, which could help to better identify and treat patients prior to development of more intractable disease., Objective: To evaluate the onset of urinary incontinence subtypes, and transitions between subtypes over 8 years, using 2 large cohorts of middle-aged and older women with incident urinary incontinence., Materials and Methods: We identified 10,349 women with incident urinary incontinence (stress, urgency, and mixed subtypes) from the Nurses' Health Study and the Nurses' Health Study II who were 41-83 years of age, using repeated mailed questionnaires. We defined stress urinary incontinence as leakage with coughing, sneezing, or activity; urgency urinary incontinence as urine loss with a sudden feeling of bladder fullness or when a toilet was inaccessible; and mixed urinary incontinence when women reported that stress and urgency symptoms occurred equally. In subsequent questionnaires 4 and 8 years later, we continued to track symptom severity and subtypes. In addition, to obtain predicted probabilities of urinary incontinence subtypes 4 years and 8 years after urinary incontinence onset, we used multivariable-adjusted generalized estimating equations with a multinomial outcome., Results: At urinary incontinence onset in 2004-2005, 56% of women reported stress urinary incontinence symptoms, 23% reported urgency urinary incontinence symptoms, and 21% reported mixed urinary incontinence symptoms. Women with stress urinary incontinence or urgency urinary incontinence at onset were likely to report the same urinary incontinence type 4 and 8 years later (stress urinary incontinence at onset: 70% and 60% reported stress urinary incontinence at years 4 and 8, respectively; urgency urinary incontinence at onset: 68% and 64% reported urgency urinary incontinence at years 4 and 8, respectively). Nonetheless, for both stress and urgency urinary incontinence, women with more severe symptoms at onset were more likely to progress to mixed urinary incontinence. Women with mixed urinary incontinence at onset had more variation over time, although the largest subset continued to report mixed urinary incontinence (45% reported mixed urinary incontinence at year 4; 43% reported mixed urinary incontinence at year 8). Few women across all urinary incontinence subtypes reported resolution of symptoms over 4-8 years of follow-up (4-12%). When considering the likelihood of remaining with or progressing to mixed urinary incontinence over follow-up, according to age, body mass index, and urinary incontinence severity, we found that older and younger women had similar predicted probability of remaining with or progressing to mixed urinary incontinence (eg, women <60 years of age at onset with severe mixed urinary incontinence had a 54% (95% confidence interval, 53-55) probability of mixed urinary incontinence 8 years later, vs 57% (95% confidence interval, 56-58) of women ≥70 years of age with severe mixed urinary incontinence at onset). Obese women were somewhat more likely to progress to mixed urinary incontinence regardless of urinary incontinence type at onset (eg, women with body mass index <25 kg/m 2 at onset with severe stress urinary incontinence had a 30% predicted probability of mixed urinary incontinence 8 years after onset, vs 36% of women with body mass index of 30+ kg/m 2 at onset with severe stress urinary incontinence)., Conclusion: Most women with incident stress and urgency urinary incontinence continued to experience similar subtype symptoms over 8 years. However, obese women and those with more severe symptoms were more likely to remain with or progress to mixed urinary incontinence., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Objectives: Third line treatment of urge urinary incontinence (UUI) and/or reduced bladder capacity is bladder augmentation. The aim of this study was to investigate whether clam enterocystoplasty (CECP) was an efficient treatment for patients who were refractory to conservative treatments of UUI and small functional bladder capacity and secondly if there was a difference in outcome in patients with neurogenic and non-neurogenic bladders. Methods: We evaluated 118 patients retrospectively treated in the period 2006-2018 at a single university hospital. Data were collected retrospectively. Patient groups were compared with Wilcoxon signed-rank test and Fisher's exact test. Results: Overall, 76% became continent with 92% using clean intermittent self-catherization (CISC) of patients with neurogenic bladder, 82% became continent and 100% were using CISC, whereas of patients with non-neurogenic bladder 64% became continence and 77% were using CISC. The median overall improvement of capacity was 296.5 mL (IQR: 142-440), 310 mL (186-467) in the neurogenic group and 214 mL (IQR: 126.8-361.5) in non-neurogenic ( p  = 0.01). Conclusion: CECP is an efficient treatment in UUI and reduced bladder capacity. Difference in outcome was seen with neurogenic patients having a bigger functional capacity and a higher rate of continence compared to the non-neurogenic.

Aims: To analyze the association between urinary incontinence and disability status in premenopausal women., Materials and Methods: The study included 120 premenopausal women recruited from six Basic Family Health Units to participate in this study. We assessed sociodemographic, gynecological, and obstetric data by using specific questions. The International Continence Society's definitions were applied to determine the presence and type of urinary incontinence, and the disability was assessed by using the 36-item version of the World Health Organization Disability Assessment Schedule (WHODAS) 2.0., Results: The WHODAS scores showed that women with urinary incontinence had a worse disability in cognition (P = .023) and mobility (P = .020) domains, in addition to the total score (P = .23). Women with mixed urinary incontinence had a worse disability in mobility domain (P = .039) than those with stress or urgency incontinence. Qualitative analyses of disability showed a significant difference between women with and without urinary incontinence (P = .033), with higher percentages of incontinent women with moderate and severe disability. Women who reported urinary incontinence had 7.69 more points on the final score of WHODAS than those who did not report this outcome., Conclusions: Urinary incontinence in women of reproductive age is associated with disability and worse scores of WHODAS when we compare them to women without urine leakage. The results presented can be useful for designing and adapting strategies for comprehensive care of women with urinary incontinence and disability, and developing rehabilitation programs based on functioning., (© 2019 Wiley Periodicals, Inc.)

Purpose: Stress urinary incontinence (SUI) and mixed urinary incontinence (MUI) lead to poor quality of life. In Japan, urinary incontinence is treated with tension-free vaginal tape (TVT) or transobturator tape (TOT) sling procedures, which involves inserting a synthetic material; however, problems arise with artificial mesh in some instances, requiring new treatment methods. Hence, laser therapy, whereby an erbium-doped yttrium aluminum garnet laser is directed into the vagina and urethra, may be useful. The study aimed to compare the effects of these three treatments., Methods: Subjects included patients who received TVT, TOT, or laser therapy (n = 50 each). The 1-h pad test, International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF), and overactive bladder symptom score were used to assess the patients before and 12 months after treatment. For laser therapy, a probe was inserted into the vagina after applying a local anesthetic to the vaginal wall, and irradiation was performed for 20 min at a wavelength of 2940 nm. This treatment was performed three times every alternate month., Results: As per the 1-h pad test and ICIQ-SF, the TVT, TOT, and laser therapy groups showed comparable improvements in SUI. For patients with MUI, some in the TVT and TOT groups showed exacerbation; however, all patients in the laser therapy group tended to improve., Conclusions: The efficacy of laser therapy for urinary incontinence was confirmed. This is the first study to report on the effect of laser therapy on urinary incontinence in Japanese women.

Competing Interests: Competing interests: None declared.

The aim of this study was to assess the effectiveness and safety of Ospemifene in the improvement of urgency component in women affected by mixed urinary incontinence (MUI) who underwent surgery with mid-urethral sling (MUS). Eighty-one patients with MUI underwent surgical intervention with MUS were enrolled. After surgical intervention 38 patients received Ospemifene 60 mg one tablet daily per os for 12 weeks. Physical examination, 3-day voiding diary, urodynamic testing were performed at the start and the follow-up after 12 weeks in the Trans-Obturator-Tape (TOT)-Alone group and TOT-Ospemifene. Patients completed the Overactive Bladder Symptom and Health-Related Quality of Life Short-Form (OAB-Q SF), International Consultation on Incontinence Questionnaire (ICIQ-UI-SF), and King' s Health Questionnaire (KHQ). A significant difference between the two groups was observed in peak flow (ml/s), in first voiding desire (ml), in maximum cystometric capacity (ml), and in detrusor pressure at peak flow (cmH 2 O) at urodynamic evaluation. A significative difference between the two groups at voiding diary was observed in the mean number of voids, urgent micturition episodes/24 h, urge urinary incontinence, and in nocturia events. The OAB-Q symptoms and OAB-Q (HRQL) scores after 12 weeks showed a significative difference between the two groups. Ospemifene is an effective potential therapy after MUSs in women with MUI improving urgency symptoms and quality of life.

Purpose: Intravesical electrical stimulation treatment (IVES) has been successfully used to treat neurogenic bladder. We report the results of an observational study regarding the use of IVES for women with overactive bladder syndrome (OAB) and/or urgency urinary incontinence (UUI)., Materials and Methods: IVES was performed in women with OAB (defined by frequency ≥8/day, nocturia ≥2/night, or ≥3 episodes of UUI on 3-day voiding diary) who failed prior medical therapy. Subjects underwent 4 weeks of treatment with an 8-Fr Detruset™ IVES catheter. Primary outcome was Patient Global Impression of Improvement (PGI-I) at 3 months. Secondary outcomes included Visual Analog Scale (VAS), Short Form OAB Questionnaire (OAB-q SF), Pelvic Floor Distress Inventory (PFDI), Pelvic Floor Impact Questionnaire (PFIQ), reduction in frequency and UUI on voiding diary, and adverse effects. Analysis was done with paired t-tests and Wilcoxon signed rank tests., Results: Seventeen subjects completed the study. At 4 weeks post-treatment, 15 improved on PGI-I (11 subjects: 'a little better', 2: 'much better', 2: 'very much better'). There were significant improvements in symptom bother and health-related quality of life as measured by OAB-q SF and pelvic organ prolapse and urinary distress as measured by PFDI. Frequency decreased from 10.3±4.3 at baseline to 8.9±2.3 (p=0.04) at 3 months. No pain was reported during treatment. There was one urinary tract infection during the study period. No other adverse events were reported., Conclusions: IVES appears to be a safe and effective novel treatment for OAB. Larger comparative studies are needed to investigate its potential for long-term treatment., Competing Interests: CONFLICTS OF INTEREST: The study was funded by EMED Technologies Corporation.

Introduction: Various authors argued that the voiding urgency component in mixed urinary incontinence (MUI) is different than urge urinary incontinence (UUI). In this last case they suggest that incontinence in MUI could be overdiagnosed in patients with SUI, misunderstanding the leak as UUI., Objetives: To evaluate clinical and urodynamic characteristics of patients with MUI and pure UUI., Methods: A retrospective study of our urodynamics database was performed evaluating 450 women with MUI and UUI. Patients with neurogenic bladder, fistulae, urethral diverticula, previous urogynecologic surgery, known infravesical obstruction, previous pelvic radiotherapy, urinary tract infection or psychiatric drugs intake. A full clinical history, physical exam, uroflowmetry, filling cystometry and pressure flow study were performed., Results: There is no difference relative to age, menopause and number of births. The presence of nocturia was bigger in the UUI group (66.4% vs. 46.1%, p 0.0004) the same as increased voiding frequency (53.6% vs. 34.6%, p 0.0006). The presence of urethral hypermobility and SUI in the physical exam was greater than MUI, meanwhile the presence of reduced vaginal trophism was bigger in the UUI group. Differences in sensibility or specificity were not found. The presence of overactive detrusor was 56.4% in pure UUI vs. 33.2% in MUI (p<0.0001). No differences in pressure flow study were found., Conclusions: There is a significant difference in the clinical and urodynamic parameters between patients with MUI and pure UUI. The urgency in patients with pure UUI could be related to overactive detrusor. It is probable that many patients with MUI just have pure SUI which could lead to positive effects in the outcomes of anti-incontinence surgery.

Objective: The objective of this study was to examine the strength and direction of the association between urinary symptoms and both poor quality sleep and daytime sleepiness among women with urgency urinary incontinence., Methods: A planned secondary analysis of baseline characteristics of participants in a multicenter, double-blinded, 12-week randomized controlled trial of pharmacologic therapy for urgency-predominant urinary incontinence in ambulatory women self-diagnosed by the 3 Incontinence Questions was performed. Urinary symptoms were assessed by 3-day voiding diaries. Quality of sleep was assessed using the Pittsburgh Sleep Quality Index (PSQI) and daytime sleepiness using the Epworth Sleepiness Scale., Results: Of the 640 participants, mean (SD) age was 56 (±14) years and 68% were white. Participants reported an average of 3.9 (±3.0) urgency incontinence episodes per day and 1.3 (±1.3) episodes of nocturia per night. At baseline, 57% had poor sleep quality (PSQI score, >5) and 17% reported daytime sleepiness (Epworth Sleepiness Scale score, >10). Most women (69%) did not use sleeping medication during the prior month, whereas 13% reported use of sleeping medication 3 or more times per week. An increase in total daily incontinence episodes, total daily urgency incontinence episodes, total daily micturitions, and moderate to severe urge sensations were all associated with higher self-report of poor sleep quality according to the PSQI (all P ≤ 0.01). Higher scores on the Bother Scale and the Health-Related Quality of Life for overactive bladder on the Overactive Bladder Questionnaire were similarly associated with higher rates of poor sleep quality (both P ≤ 0.01). In subgroup analysis of those who took sleeping medications less than twice a week, there was still a significant relationship between incontinence measures and quality of sleep as measured by the PSQI. In multivariable analyses, greater frequency of nighttime urgency incontinence was associated with poor sleep quality (P = 0.03)., Conclusions: Among ambulatory women with urgency urinary incontinence, poor sleep quality is common and greater frequency of incontinence is associated with a greater degree of sleep dysfunction. Women seeking urgency urinary incontinence treatment should be queried about their sleeping habits so that they can be offered appropriate interventions.

Objectives: It is hypothesized that urethral dysfunction is central in mixed urinary incontinence (MUI) in women, since urine entering the proximal urethra under increased intra-abdominal pressure provokes a urethro-detrusorial reflex and involuntary detrusor contraction. Mid-urethral slings have been proposed as a solution. Our primary objective was to evaluate the long-term subjective and objective outcomes on continence and other urinary symptoms of a trans-obturator mid-urethral sling (TOT) procedure. Our secondary objectives were to determine its impact on quality of life (QoL), and to investigate which factors influence outcomes., Study Design: This is a single-centre prospective study on a consecutive series of 86 women who underwent TOT for MUI as defined by ICS/IUGA. Since the definition of MUI that we used is symptom-based, we included patients both with and without associated detrusor overactivity. All patients underwent placement of Monarc ® Subfascial Hammocks., Statistical Analysis: We used the McNemar chi-square test, the paired t-test and Fisher's exact test. A logistic regression model and odds ratios were used to assess age, parity, body mass index, menopausal status, preoperative detrusor over-activity, and detrusor pressure at maximum flow as possible factors for treatment failure. Only those that were statistically significant in the univariate analysis were included in the multivariate analysis., Results: With a mean follow-up of 59 months, SUI was cured objectively in 83.7% of patients and subjectively in 87.2%. Three patients underwent further anti-incontinence surgery. The continence rates were 74.4% for urgency urinary incontinence (UUI) and 66.3% for SUI-UUI. The patient-reported success rate was 87.2% ('much better' or 'very much better' on Patient Global Impression of Improvement scale). There were statistically significant improvements in all domains except general health. The univariate analysis found no significant risk factor for persistence of SUI. Median age >60 years and menopause were predictive for persistence of UUI. Median and mean age >60 years were predictive of persistence of overall incontinence. In the multivariate model, all variables lost their statistical significance., Conclusion: Our study demonstrates TOT surgery can be performed for patients with MUI following unsuccessful conservative therapy. We also demonstrate that menopause and age >60 are risk factors for failure. This should be considered when counselling preoperatively., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Aims: To determine the effect of pelvic organ prolapse (POP) repair on post-operative detrusor overactivity (DO) in women who have underwent incontinence surgery, using multivariate analysis., Methods: A retrospective study was carried out on a cohort of 105 women who underwent incontinence surgery. In 39 of the patients this surgery was associated with pelvic organ prolapse repair. Clinical and urodynamic data were collected pre- and 3 months post-operatively. A multivariate statistical analysis was performed to detect confounding factors which could influence on the risk factors associated with post-operative detrusor overactivity., Results: On univariate analysis, the following pre-operative factors were associated with post-operative detrusor overactivity: symptomatic mixed urinary incontinence, rectocele, detrusor overactivity, voided volume on free uroflowmetry, maximum cystomanometric capacity, and performing concomitant pelvic organ prolapse repair. Multivariate analysis, by means of confounding factors elimination, revealed that only pre-operative rectocele and detrusor overactivity were independent risk factors., Conclusions: The pelvic organ prolapse repair acts as a confounding factor. Women with a pre-operative rectocele and detrusor overactivity are on a greater risk to develop post-operative detrusor overactivity and, therefore, they should be informed., (© 2017 Wiley Periodicals, Inc.)

Aims: To identify if the short term association of pressure flow rates with resolution of overactive bladder (OAB) is maintained in the long term in patients with mixed urodynamic incontinence treated with a retropubic midurethral sling. To assess if other demographic factors are associated with the long term resolution of OAB., Methods: This was follow up study of a consecutive case series of 100 patients treated with a MUS at a single center followed up with questionnaires. Preoperative pressure flow studies were compared to the resolution of urgency and urgency incontinence after surgery., Results: A total of 6.25 years after surgery, resolution of urgency and urgency incontinence was associated with a higher preoperative flow rate (26.7 mL/s vs 19.1 mL/s P = 0.02) and a higher flow rate centile (33.1 vs 14.0 P = 0.01). No other demographic parameters were associated with resolution of OAB., Conclusions: The long term outcome and resolution of urgency and urgency incontinence can be predicted by preoperative pressure flow studies over 6 years after surgery., (© 2017 Wiley Periodicals, Inc.)

Background: Urinary incontinence (UI) is likely to be high in Aboriginal women in rural Australia due to risk factors including high body mass index, parity and diabetes. However, UI appears to be under-reported with limited information on whether women access appropriate care., Aims: To assess whether women who access specialist gynaecological services in rural and remote Top End Northern Territory (NT) through the specialist outreach program (SONT) are receiving care for UI aligned with best practice., Methods: Review of all 1426 SONT referrals in 2012, with audit of management for those women referred for UI or prolapse., Results: Of 1426 SONT referrals, there were 43/1426 (3%) women referred for UI, with 34/43 (79%) attending. Of those referred, 31/43 (72%) were Aboriginal. Of twenty-six women diagnosed with probable stress UI, less than a fifth, 5/26 (19%), were referred to physiotherapy, with 2/5 (40%) attending appointments. Referral occurred for 14/23 (61%) of those suitable for urodynamics but only 6/14 (43%) attended. Just under half of women 7/16 (14%) with stress UI were referred for surgery, with 6/7 (86%) attending., Conclusion: In rural and remote Top End NT, specialist health service management of female UI could be improved by increased provision of current best-practice and an integrated multi-disciplinary team approach with allied health. Under-reporting and under-referral for female UI could be addressed by increasing awareness among community and primary healthcare providers of the problem of female UI and the conservative, medical and surgical treatments available., (© 2017 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.)

Objective(s): To present data of standardized ambulatory urodynamic monitoring (AUM) performed in women with overactive bladder syndrome (OAB) and to evaluate the relevance of AUM data with clinical findings of the patients., Study Design: Records of women with symptoms of OAB were retrospectively reviewed (n=249). Of women fulfilling the Overactive Bladder Awareness Tool (OAB-V8) with a score ≥8 and the 3-day voiding diary (VD) with a frequency >7/day (n=167), those who underwent urodynamic investigation were selected (n=76). The data of this study were retrieved from the records of Ankara University Cebeci Hospital and based on the AUM findings of single voiding cycle of women with OAB. AUM, which is among the institutionally approved primary urodynamic investigation methods, is performed with LUNA ambulatory monitoring recorder (MMS™) in the clinical setting with a standardized technique, in reproducing lower urinary tract symptoms of women since 2011. The relationship of the urodynamic data with the clinical findings were evaluated., Results: AUM traces of women (n=76) with OAB revealed 63.1% DO, 64.4% urgency and 77.7% urinary incontinence of which were 14.4% urgency urinary incontinence (UUI), 25% stress urinary incontinence (SUI) and 38.1% mixed urinary incontinence (MUI). OAB patients with DO reported more urinary incontinence episodes/day, nocturia and mixed urinary incontinence in the voiding diary (p<0.04) and had significantly higher irritative symptom bother reflected by the questionnaires (p<0.04). Women with DO were more likely to be postmenopausal (p=0.02) and were found to have more urgency (p<0.001), urgency episodes (p=0.05) and incontinence (urge and mixed) (p<0.001). However, no association was found between the extent of pelvic organ prolapse and the presence of DO., Conclusions: AUM performed with a standardized technique during single voiding cycle seems to be a reliable method in reproducing symptoms of women with OAB. It provides both clinically relevant findings and objective documentation of urgency which is the main symptom for OAB. The detection of DO according to the ICS definition were also found to be concordant with urodynamicaly observed urgency and urinary incontinence. Objective and subjective clinical findings of OAB were found to be more severe in women with DO., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Purpose: Nocturia is common and bothersome in older adults, especially those who are also incontinent. Since nocturnal polyuria is a major contributor, we examined factors associated with nocturnal polyuria in this population to identify those possibly amenable to intervention., Materials and Methods: We analyzed baseline data from 2 previously completed studies of urge urinary incontinence. The studies involved 284 women (mean age ± SD 72.9 ± 7.9 years) who also completed 3-day voiding diaries. Participants with a nocturnal polyuria index greater than 33% were categorized as having nocturnal polyuria (nocturnal polyuria index = nocturnal urinary volume per 24-hour urine volume). Associations between nocturnal polyuria and various demographic, clinical and sleep related parameters were determined., Results: Overall 55% of the participants had nocturnal polyuria. Multivariable regression analysis revealed that age, body mass index, use of angiotensin converting enzyme inhibitor/angiotensin receptor blocker, time spent in bed and duration of first uninterrupted sleep were independent correlates of nocturnal polyuria. Participants with a larger nocturnal excretion reported a shorter duration of uninterrupted sleep before first awakening to void and worse sleep quality despite spending similar time in bed., Conclusions: Body mass index, use of angiotensin converting enzyme inhibitor/angiotensin receptor blockers, time in bed and duration of uninterrupted sleep before first awakening to void are independently associated with nocturnal polyuria in older women with urge urinary incontinence, and are potentially modifiable. These findings also confirm the association between sleep and nocturnal polyuria. Further studies should explore whether interventions to reduce nocturnal polyuria and/or increase the duration of uninterrupted sleep before first awakening to void would help to improve sleep quality in this population and thereby reduce or eliminate the need for sedative hypnotics., (Copyright © 2017 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.)

Introduction: Overactive bladder (OAB) is one of the most common syndromes of lower urinary tract dysfunction. Besides standard therapy using anticholinergic medications, comprehensive management of overactive bladder includes physiotherapy., Aim: To test the clinical effectiveness and safety of autonomous electrostimulation device "Erektron" in treating OAB in women., Materials and Methods: The study was conducted at the Urology and Gynecology Clinic of the Innovative Medical Technology Center between 25.04.2014 and 30.01.2015. It included 20 women with newly diagnosed OAB both with and without urinary urgency incontinence or urinary stress incontinence. The patients were divided into 2 groups. All patients were treated with the first line anticholinergic agent solifenacin 5 mg daily. In patients of group 1, anticholinergic therapy was administered concurrently with intravaginal electrostimulation using "Erektron" device., Results: In both groups, the treatment resulted in positive results, but a more pronounced improvement was found in group 1 patients with mixed incontinence., Conclusion: Autonomous electrostimulation device MT-RV "Erektron" can be used in comprehensive management of patients with OAB, including those with stress urinary incontinence.

Objectives: To evaluate the cost-effectiveness of first-line treatment of Overactive Bladder (OAB) with fesoterodine relative to mirabegron, from the Spanish National Health System (NHS) perspective., Methods: A decision tree model was developed to represent a typical clinical process of 52-week of treatment for an OAB patient with urge urinary incontinence (UUI) initiating first-line therapy with fesoterodine 4mg, including optional titration to 8mg, vs.mirabegron 50mg. Efficacy data were obtained from a Bayesian indirect treatment meta-analysis. Patients with UUI of less than one episode/day were defined as treatment responder and persistence was assessed at weeks 4, 12 and 24. At week 12, non-responders discontinued treatment permanently. Quality-adjusted life years (QALYs) were calculated based on time spent in responder and non-responder states. OAB-related drug and medical care costs including physician visits, laboratory tests, incontinence pads, and comorbidities (fracture, skin infection, urinary tract infections and depression) were modeled and expressed in €2015., Results: At week 52, the percentage of responders was 20.8% for patients starting on fesoterodine 4mg who optionally titrated to 8mg and 19.4% for patients treated with mirabegron. QALYs were slightly higher with fesoterodine than mirabegron (0.7703vs. 0.7668, difference=0.0035). Fesoterodine treatment also had slightly higher total costs than mirabegron (3,296€vs. 3,217, difference=79€), resulting in a cost of 22,523/QALY€ gained for fesoterodine versus mirabegron. Probabilistic sensitivity analysis confirmed the slight advantage of fesoterodine with a 61.1% probability of being cost-effective at the 30,000€ willingness-to-pay for 1QALY threshold., Conclusions: Given the relatively small 1-year cost difference between the two treatments, fesoterodine can be considered a cost-effective option relative to mirabegron for the first-line management of OAB with UUI in Spain., (Copyright © 2016 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.)

Background: Urinary incontinence is common, particularly in women. Urodynamic studies (UDS) can accurately assess the condition. Less invasive objective measuring tools correlate with urodynamic findings, but the Arabic version of the Urogenital Distress Inventory-6 (UDI-6) questionnaire has not been previously correlated with UDS in Arabian patients., Objective: To correlate the Arabic version of the UDI-6 with urodynamic findings in Arabian women with urinary incontinence., Design: Prospective., Setting: Tertiary referral urology clinic., Patients and Methods: All female patients presenting with urinary incontinence between July 2013 to March 2014. Patients answered the Arabic UDI-6 questionnaire and underwent a history and clinical examination, urine culture and UDS., Main Outcome Measures: Correlation between Arabic UDI-6 questionnaire score and urodynamic diagnosis., Results: Eighty-seven women with a mean age of 57 (range, 22-72) years completed the UDI-6 and underwent UDS. The questionnaire revealed that 20 (23%) patients had urge incontinence, 28 (32%) had stress incontinence and 39 (45%) had mixed incontinence. As diagnosed by UDS, 26 (30%) had urge incontinence, 37 (42%) had stress incontinence, 16 (18%) had mixed incontinence and 8 (9%) had no abnormality. Eighty-six percent of patients (24/28) with pure stress urinary incontinence (SUI) symptoms had a positive UDS, and 55% (11/20) of patients with pure urge incontinence symptoms had a positive UDS. Of all patients with positiveresponse to the question for SUI, 53/67, 79% had positive UDS diagnosis with a correlation coefficient of 0.65 (P < .01). Of all patients with positive responses for urge incontinence, 27/59, 45.8% had positive UDS diagnosis with a moderate correlation coefficient of 0.38 (P < .01)., Conclusions: The validated Arabic UDI-6 correlates significantly with UDS findings in Arabian women, particularly in women with SUI., Limitations: The sample size was relatively small, which prevented sub-analyses. Patient comorbidities were not evaluated.

Introduction and Hypothesis: Urinary incontinence (UI) is common and the relationship among its subtypes complex. Our objective was to describe the natural history and predictors of the incontinence subtypes stress, urgency, and mixed, in middle-aged and older US women. We tested our hypothesis that UI subtype history predicted future occurrence, evaluating subtype incidence/remission over multiple time points in a stable cohort of women., Methods: We analyzed longitudinal urinary incontinence data in 10,572 community-dwelling women aged ≥50 in the 2004-2010 Health and Retirement Study. Mixed, stress, and urgency incontinence prevalence (2004, 2006, 2008, 2010) and 2-year cumulative incidence and remissions (2004-2006, 2006-2008, 2008-2010) were estimated. Patient characteristics and incontinence subtype status 2004-2008 were entered into a multivariable, transition model to determine predictors for incontinence subtype occurrence in 2010., Results: The prevalence of each subtype in this population (median age 63-66) was 2.6-8.9 %. Subtype incidence equaled 2.1-3.5 % and remissions for each varied between 22.3 and 48.7 %. Incontinence subtype incidence predictors included ethnicity/race, age, body mass index, and functional limitations. Compared with white women, black women had decreased odds of incident stress incontinence and Hispanic women had increased odds of stress incontinence remission. The age range 80-90 and severe obesity predicted incident mixed incontinence. Functional limitations predicted mixed and urgency incontinence. The strongest predictor of incontinence subtype was subtype history. The presence of the respective incontinence subtypes in 2004 and 2006 strongly predicted 2010 recurrence (odds ratio [OR] stress incontinence = 30.7, urgency OR = 47.4, mixed OR = 42.1)., Conclusions: Although the number of remissions was high, a previous history of incontinence subtypes predicted recurrence. Incontinence status is dynamic, but tends to recur over the longer term.

Aims: There are few population-based studies evaluating the epidemiology of overactive bladder syndrome (OAB) in women, especially in the climacteric stage where there is a decrease in estrogen production. This study aimed to assess the prevalence of OAB and associated factors in climacteric Brazilian women., Methods: A descriptive, exploratory, cross-sectional study was conducted between September 2012 and June 2013 with 749 women (a population-based household survey). The dependent variable was OAB, defined as the presence of urinary urgency, with or without urinary incontinence, and when there was no concomitant stress urinary incontinence. The independent variables were sociodemographic data, health related habits and problems, self-perception of health, and gynecological background. Statistical analysis was carried out by Chi-square test and Poisson regression using the backward selection criteria., Results: Mean age was 52.5 (± 4.4) years. With regard to menopausal status, 16% were premenopausal, 16% perimenopausal and 68% postmenopausal. The prevalence of OAB was 7.8%. The vast majority of women had only urinary urgency. Only two women who responded to the interview reported urge incontinence. In the final statistical model, vaginal dryness (PR 1.75; 95% CI 1.13-2.69; p=0.012) and bilateral oophorectomy (PR 2.21; 95% CI 1.11-4.40; p=0.025) were associated with a greater prevalence of OAB., Conclusions: Health professionals should adopt a proactive behavior in surgically menopausal women and those with a history of genital atrophy to identify and treat OAB, thus contributing to an improved quality of life and healthier aging., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

Introduction: To determine the significance of bladder trabeculations seen on preoperative cystoscopy prior to midurethral sling surgery with respect to lower urinary tract symptoms and sling outcomes., Materials and Methods: This retrospective study included women with preoperative cystoscopy who underwent midurethral slings for urinary incontinence from 2006-2009. Cystoscopic findings of bladder trabeculations, as well as pre and postoperative urinary symptoms were recorded. Patients with and without bladder trabeculations were compared with respect to baseline characteristics, lower urinary tract symptoms, and sling outcomes., Results: Of the 241 women included in the study, 14.9% had trabeculations on preoperative cystoscopy. At baseline, women with trabeculations were more likely to be older (64.8 years versus 57.8 years, p < 0.01), and have lower mean maximum cystometric capacity (341 mL +/- 136 versus 436 mL +/- 148, p < 0.01), compared to those without trabeculations. More women with trabeculations had mixed incontinence (p < 0.01) and less pure stress incontinence (p < 0.01) preoperatively. There was no difference between women with and without trabeculations with respect to pre and postoperative symptoms of urgency, frequency, and nocturia. Women with preoperative trabeculations were more likely to have preoperative treatment with anticholinergics (p = 0.02) and had a three times higher risk of postoperative sling failure (HR 2.95 [CI 1.11-7.85], p = 0.03)., Conclusions: Preoperative cystoscopic bladder trabeculations are associated with significantly higher rate of midurethral sling failure. Trabeculations were not associated with pre or postoperative lower urinary tract symptoms.

Introduction: Anal incontinence (AI) has been associated with sexual complaints. The Pelvic Organ Prolapse/Incontinence Sexual Questionnaire-IUGA Revised (PISQ-IR) has been validated to measure sexual function in sexually active (SA) and non-SA (NSA) women with pelvic floor disorders (PFD) including AI. We describe symptoms in women with PFDs including AI using this instrument., Methods: This was a planned secondary analysis of data collected for the validation of the PISQ-IR. SA and NSA women with symptoms of pelvic organ prolapse, urinary incontinence (UI) and/or AI at 12 US and 5 UK sites were recruited. The Female Sexual Function Index (FSFI) and PISQ-IR were completed in addition to the Pelvic Floor Distress Inventory (PFDI), and other measures., Results: Of 872 women enrolled, 90 (10%) reported AI. Compared with women without AI, women with AI were more likely to report stress UI (p = 0.007), urgency UI (p < 0.001), mixed UI (p < 0.001), diabetes (p = 0.036) and depression (p < 0.001), and to show larger genital hiatus measurements (p = 0.005) and more underactive pelvic floor muscles (p = 0.011). Furthermore, scores on the PFDI showed greater bother (p = 0.013), particularly the colorectal subscale (p < 0.001). While sexual activity was similar between the groups, FSFI desire (p = 0.016), PISQ-IR 'condition-specific' (p = 0.03) and 'global quality' (p = 0.046) domains were worse in women with AI. In logistic regression analysis, only the PISQ-IR 'condition-specific' domain was associated with AI when controlling for other confounders (OR 0.27, 95% CI 0.10 - 0.72, p = 0.009)., Conclusions: Women with AI have similar rates of sexual activity but poorer sexual function than women without AI. The PISQ-IR may be most appropriate to characterize these conditions.

Objective: To evaluate and compare the effectiveness of biofeedback therapy (BF) in children with treatment refractory overactive bladder (OAB) and dysfunctional voiding (DV)., Methods: This study was performed between April 2012 and March 2014. Patients with treatment refractory OAB and DV were included. All patients had 3 months of BF. Patients' urologic system symptoms and uroflow parameters before BF and 3 months after BF and response rates were compared., Results: Forty-five patients completed the study. Significant improvement was seen in urinary tract infections, urge incontinence, fractionated voiding, constipation, voided volume, maximum flow rate (Qmax), average flow rate (Qave), and postvoiding residue for patients with DV and in urinary tract infection, frequency, urge incontinence, Qmax, Qave, voiding time, and postvoiding residue for patients with OAB. Overall, better results were observed in patients with DV., Conclusion: BF is an effective treatment modality in children with treatment refractory OAB and DV; however, patients with DV show better improvement., (Copyright © 2015 Elsevier Inc. All rights reserved.)