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Importance: Supervised pelvic floor muscle training (PFMT) has been recommended as the first-line treatment for women with stress urinary incontinence (SUI), but more evidence on whether adjunctive methods would provide additional benefits is needed., Objective: To compare the efficacy of PFMT with or without a home-based pressure-mediated biofeedback (BF) device., Design, Setting, and Participants: This multicenter assessor-blinded randomized clinical trial was conducted in the obstetric clinics of 5 participating tertiary hospitals in China. Participants included eligible women with new-onset postpartum SUI who were enrolled from March 28, 2022, to October 13, 2023., Intervention: All participants received 3 months of supervised PFMT and were randomized to either the intervention (PFMT with a home-based pressure-mediated BF device) or the control group (home-based PFMT)., Main Outcome and Measures: The primary outcome was the severity of urinary incontinence evaluated by the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form after 3 months of supervised PFMT. The secondary outcomes included the cure and improvement rates, PFM strength, quality of life, self-efficacy, and adherence., Results: A total of 452 participants (median age, 34 [IQR, 31-36] years; median body mass index [calculated as the weight in kilograms divided by the height in square meters], 23.71 [IQR, 21.37-25.97]; median time since delivery, 50 [IQR, 43-61] days) were included in the analysis, with 223 in the intervention group and 229 in the control group. Compared with the control group, the intervention group achieved a significantly greater reduction in incontinence severity (median, 3.00 [IQR, 1.00-6.00] vs 2.00 [IQR, 0-4.00] points; z = -3.05; P = .002), significantly increased cure rate (45 of 223 [20.2%] vs 20 of 229 [8.7%]; z = 12.02; P = .001) and improvement (132 of 223 [59.2%] vs 102 of 229 [44.5%]; z = 9.71; P = .002), significantly greater pelvic floor muscle strength (median, 26.00 [IQR, 17.00-38.00] vs 21.00 [IQR, 13.50-33.50] cm H2O; z = -2.28; P = .02), and a significantly greater correlation between subjective and objective adherence (r = 0.825 vs r = 0.627)., Conclusion and Relevance: In this randomized clinical trial, the efficacy of pressure-mediated BF combined with PFMT was superior to that of PFMT alone. These findings support the use of pressure-mediated BF devices for improving treatment outcomes for patients with SUI., Trial Registration: ClinicalTrials.gov Identifier: NCT05115864.

Background: This pooled analysis of randomized controlled studies investigated the safety and efficacy of onabotulinumtoxinA in male and female patients with overactive bladder (OAB)., Methods: Data were pooled from four similarly designed trials in North America and Europe. Adults with idiopathic OAB for ≥6 months inadequately managed by at least one anticholinergic were randomized 1:1 or 2:1 to receive onabotulinumtoxinA 100 U or matched placebo in Cycle 1 and could request open-label retreatment with onabotulinumtoxinA 100 U at ≥12 weeks. Efficacy outcomes at Week 12 included the primary endpoint of mean urinary incontinence (UI) episodes per day and other variables, such as the proportion of patients with ≥50% reduction in daily UI episodes. Safety was assessed by monitoring treatment-emergent adverse events (TEAEs). Analyses by sex were descriptive. Males were further analyzed by benign prostatic hyperplasia (BPH) diagnosis status., Results: In the pooled population (N = 1564), there were 194 males (12.4%) and 1370 females (87.6%). Mean number of baseline UI episodes per day was 4.9 in males and 5.5 in females. At Week 12, numerically greater mean reductions from baseline in number of daily UI episodes were observed with the onabotulinumtoxinA 100 U group (females: -3.0; males: -2.2) versus placebo (females: -1.1; males: -1.3). Achievement of ≥50% reduction in daily UI episodes was numerically greater with onabotulinumtoxinA 100 U (females: 64.8%; males: 61.2%) versus placebo (females: 30.6%; males: 44.8%), and numerically higher in males without BPH (onabotulinumtoxinA: 65.1%; placebo: 50.9%) versus with BPH (onabotulinumtoxinA: 54.3%; placebo: 36.6%). A total of 34.7% of males and 39.4% of females experienced at least one TEAE in the first 12 weeks during treatment Cycle 1. Urinary tract infection rate was 13.1% in females and 4.2% in males; incidence of hematuria was 6.8% in males and 1.1% in females. Incidence of urinary retention (defined as incomplete emptying, requiring catheterization) was 2.7% in females and 4.7% in males., Conclusion: OnabotulinumtoxinA 100 U was efficacious and well tolerated in men and women with OAB, including in males with and without BPH. No new safety findings were identified when data were analyzed by sex., (© 2024 The Author(s). Neurourology and Urodynamics published by Wiley Periodicals LLC.)

Aim: To develop a conceptual framework for proactive health behavior among middle-aged and older adult females with urinary incontinence., Design: Qualitative grounded theory study., Background: There is a growing body of research emphasizing the pivotal significance of proactive health behavior. Proactive health behavior can empower patients to actively manage their illnesses and facilitate disease recovery. Clearly defining patients' relevant beliefs and assumptions regarding proactive health behavior can effectively promote their adoption. However, there is currently a lack of relevant research in this area., Methods: We conducted in-depth interviews with middle-aged and older adult females with urinary incontinence (n = 17) and nursing caregivers (n = 9). We used theoretical sampling, whlie conducting continuous comparative analysisi and data collection., Results: The study has yielded a substantive theory to facilitate healthcare professionals' comprehension of proactive health behavior in middle-aged and older adult females with urinary incontinence. The foundation for middle-aged and older adult females to adopt proactive health behavior is having a certain level of health literacy regarding their conditions. Patients' internal motivation to engage in proactive health behavior includes a sense of health responsibility and health demands. Additionally, external support received by patients can also facilitate their adoption of proactive health behavior. The proactive health behavior practices of middle-aged and older adult females mainly include proactive medical care behavior and establishing a healthy lifestyle., Conclusions: The conceptual framework established in this study offers theoretical support for middle-aged and older adult females with urinary incontinence to adopt proactive health behavior. It provides a basis for future exploration of proactive health behavior among this demographic and informs the development of more effective health interventions and support measures tailored to their needs., Impact: The study specifically elucidates the mechanisms and manifestations of proactive health behavior adopted by middle-aged and older adult females with urinary incontinence, laying the foundation for clarifying the level of proactive health among patients and implementing corresponding intervention measures. Additionally, it can also serve as a reference for related research on other diseases., (© 2024 Wiley Periodicals LLC.)

Purpose of Review: The AMS 800 has dominated the treatment of postprostatectomy urinary incontinence (PPUI) due to intrinsic sphincter deficiency (ISD) for five decades. A narrative review from June 2022 to June 2024 was conducted using 'artificial urinary sphincter' (AUS) MeSH terms in Embase. We extracted information on innovative AUS, randomized controlled trials (RCTs) or prospective studies, and systematic reviews. We evaluated the latest guidelines and consensus and analyzed current trends to discuss options for advancing AUS practices., Recent Findings: Of 465 papers identified, 320 were excluded (irrelevant, duplicates, non-AUS devices, non-English, veterinary), and 145 were reviewed, with 24 selected: seven on novel AUS in development, 7 with higher-level evidence (1 RCT, 1 prospective, 4 systematic reviews, 1 nonsystematic review), and 9 retrospective relevant studies [pressure regulating balloon (PRB), revision strategies, radiotherapy history, manual dexterity/cognition, transscrotal vs. transperineal approach]. The final paper summarized current guidelines from Asia & Pacific on AUS., Summary: In the past 2 years, six novel AUS have emerged, two female RCTs are ongoing, the SATURN study published its 1-year outcomes, and four systematic reviews on female AUS were conducted. These findings enhance evidence levels and position novel AUS to challenge the Gold Standard., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

The first line of treatment for urinary incontinence is pelvic floor muscle (PFM) training, aimed at reducing leakage episodes by strengthening these muscles. However, many women struggle with performing correct PFM contractions or have misconceptions about their contractions. To address this issue, we present a novel PFM contraction quality assessment system. This system combines a PFM contraction detector with a maximal PFM contraction performance classifier. The contraction detector first identifies whether or not a PFM contraction was performed. Then, the contraction classifier autonomously quantifies the quality of maximal PFM contractions across different features, which are also combined into an overall rating. Both algorithms are based on artificial intelligence (AI) methods. The detector relies on a convolutional neural network, while the contraction classifier uses a custom feature extractor followed by a random forest classifier to predict the strength rating based on the modified Oxford scale. The AI algorithms were trained and tested using datasets measured by vaginal dynamometry, combined in some cases with digital assessment results from expert physiotherapists. The contraction detector was trained on one dataset and then tested on two datasets measured with different dynamometers, achieving 97% accuracy on the first dataset and 100% accuracy on the second. For the contraction performance classifier, the results demonstrate that important clinical features can be extracted automatically with an acceptable error. Furthermore, the contraction classifier is able to predict the strength rating within a ±1 scale point with 97% accuracy. These results demonstrate the system's potential to enhance PFM training and rehabilitation by enabling women to monitor and improve their PFM contractions autonomously.

Background: (1) The pelvic floor muscle training is an effective first choice intervention., Background: (2)  Scarcity of studies describing the protocols of pelvic floor muscle training detail., Background: (3)  There is no consensus between the instructions contained in the different protocols., Objective: to map pelvic floor muscle training protocols available in the literature for the management of post-prostatectomy urinary incontinence., Method: this is a scoping review conducted in six databases. Information retrieval was performed using a specific instrument, including: title, authorship, year of publication, journal, objective, study design and description of the protocols' content., Results: a total of 24 studies were included, which resulted in different protocols. The most frequent recommendations were the following: three sessions per day; with a frequency of six to 15 contractions per session; performing the exercises in the lying, sitting, and standing positions. The most cited guidelines in the protocols were anal sphincter and bulbocavernosus muscle contractions. All protocols followed the principle of regular pelvic floor muscle contraction, but there was no consensus regarding the start of the protocol, treatment duration, contraction/relaxation time, and intensity of the contraction force., Conclusion: different orientations were found in the pelvic floor muscle training protocols post-prostatectomy urinary incontinence, with emphasis on contraction time, relaxation time, number of contractions per session, training position, and protocol duration time. Different concepts were adopted to define urinary continence in the protocols. It is necessary to develop consensus guidelines that clearly define the parameters of training protocols.

Background: Pelvic floor dysfunction (PFD) is a disease of weakened pelvic floor support tissues, leading to changes in the pelvic organ position and function of pelvic organs, with long-term effects on women. This study aimed to assess pelvic floor function using electrophysiology and clinical symptoms, exploring the risk factors for PFD one month postpartum., Methods: This cross-sectional study included 845 women from postpartum outpatient clinic of Nantong Affiliated Hospital from August 2019 to October 2021. Pelvic floor muscle strength was evaluated via pelvic floor surface electromyography. Clinical symptoms (urinary incontinence (UI) and pelvic organ prolapse) were diagnosed by gynecologists. Sociodemographic, pregnancy, and obstetrical data were obtained from self-reported questionnaires and electronic records., Results: The study identified maternal age, parity, immigrant status, and economic income as factors were related to PFD. Gestational constipation increased the risk of abnormal resting muscle strength (OR:1.553, 95%CI: 1.022-2.359). Cesarean delivery was associated with higher rates of abnormal resting muscle strength than vaginal delivery (post-resting stage: OR, 2.712; 95% CI, 1.189-6.185), but a decreased incidence of UI (OR: 0.302; 95% CI, 0.117-0.782). Increased gestational weight gain was correlated with a greater risk of developing UI (OR:1.030, 95%CI: 1.002-1.058). Women with vaginal inflammation faced a higher risk of abnormal fast-twitch muscle (OR: 2.311, 95%CI: 1.125-4.748)., Conclusions: In addition to uncontrollable factors like mode of delivery, age, and parity, interventions targeting weight gain and constipation during pregnancy and vaginal flora could mitigate the risks of PFD. Educational programs for pregnant women should emphasize a proper diet and lifestyle. For women with vaginal inflammation, clinical treatment should be carried out as soon as possible to avoid further aggravating the damage to the pelvic floor muscles., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Gao et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: The standard artificial urinary sphincter (AUS) is an implantable device for the treatment of urinary incontinence by applying a pressure loading around the urethra through an inflatable cuff, often inducing no-physiological stimulation up to tissue degenerative phenomena. A novel in silico approach is proposed to fill the gap of the traditional procedures by providing tools to quantitatively assess AUS reliability and performance based on AUS-urethra interaction., Methods: The approach requires the development of 3D numerical models of AUS and urethra, and experimental investigations to define their mechanical behaviors. Computational analyses are performed to simulate the urethral lumen occlusion by AUS inflation under different pressures, and the lumen opening by applying an intraluminal pressure progressively increased under the AUS action (Abaqus Explicit solver). The AUS reliability is evaluated in terms of tissue stimulation by the mechanical fields potentially responsible for vasoconstriction and tissue damage, while the performance by the intraluminal pressure that causes the lumen opening for a specific occlusive pressure, showing the maximum urethral pressure for which continence is guaranteed., Results: The present study implemented the procedure considering the gold standard AMS 800 and a novel patented AUS. Results provided the comparison between two sphincteric devices and the evaluation of the influence of different building materials and geometrical features on the AUS functionality., Conclusions: The approach was developed for the AUS, but it could be adapted also to artificial sphincters for the treatment of other anatomical dysfunctions, widening the analyzable device configurations and reducing experimental and ethical efforts., (© 2024 International Center for Artificial Organ and Transplantation (ICAOT) and Wiley Periodicals LLC.)

Introduction and Hypothesis: Condition-specific sexual questionnaires are important patient-reported outcome measures. The aim of this study was to translate and validate the Pelvic Organ Prolapse/Incontinence Sexual Questionnaire-International Urogynecology Association Revised (PISQ-IR) into Brazilian Portuguese and to clinically validate it in a Brazilian Portuguese-speaking population., Methods: Translation and validation of the PISQ-IR was performed according to the International Urogynecological Association-recommended process and guidelines. For external validity, PISQ-IR subscales were compared with the clinical measures, Pelvic Organ Prolapse Quantification system (POP-Q) stage, pelvic floor muscle tone, and Oxford Grading Scale (Pearson correlations). Descriptive statistics, internal consistency (Cronbach's alpha coefficient), and test-retest reliability (interclass correlation coefficient) were calculated for all PISQ-IR subscales., Results: A total of 120 sexually active and 106 not sexually active women were enrolled in the study between March 2015 and July 2019. Internal consistency was acceptable, with Cronbach's alpha values 0.60-0.80, except for the sexual arousal and orgasm, sexual arousal and partner-related issues, sexual arousal and condition-specific issues, global rating of sexual quality and condition impact subscales. PISQ-IR demonstrated good reliability (α > 0.6, CIC = 0.996). The agreement for each individual questionnaire item also individually presented substantial agreement between the assessments (κ 0.61-0.8). There was a correlation between PISQ-IR and POP, mixed, stress and fecal incontinence diagnosis and a positive correlation with pelvic floor muscle function according to the Oxford Scale in sexually active women. For sexually inactive women there was a correlation between PISQ-IR and mixed urinary symptoms., Conclusions: The Brazilian Portuguese version of PISQ-IR is a reliable and valid tool that can be easily used for the identification and assessment of sexual function in Brazilian Portuguese-speaking women with pelvic floor disorders., (© 2024. The International Urogynecological Association.)

Objective: To assess the effectiveness of pre- and postoperative supervised pelvic floor muscle training (PFMT) on the recovery of continence and pelvic floor muscle (PFM) function after robot-assisted laparoscopic radical prostatectomy (RARP)., Patients and Methods: We carried out a single-blind randomised controlled trial involving 54 male patients scheduled to undergo RARP. The intervention group started supervised PFMT 2 months before RARP and continued for 12 months after surgery with a physiotherapist. The control group was given verbal instructions, a brochure about PFMT, and lifestyle advice. The primary outcome was 24-h pad weight (g) at 3 months after RARP. The secondary outcomes were continence status (assessed by pad use), PFM function, and the Expanded Prostate Cancer Index Composite (EPIC) score., Results: Patients who participated in supervised PFMT showed significantly improved postoperative urinary incontinence (UI) compared with the control group (5.0 [0.0-908.0] g vs 21.0 [0.0-750.0] g; effect size: 0.34, P = 0.022) at 3 months after RARP based on 24-h pad weight. A significant improvement was seen in the intervention compared with the control group (65.2% continence [no pad use] vs 31.6% continence, respectively) at 12 months after surgery (effect size: 0.34, P = 0.030). Peak pressure during a maximum voluntary contraction was higher in the intervention group immediately after catheter removal and at 6 months, and a longer duration of sustained contraction was found in the intervention group compared with the control group. We were unable to demonstrate a difference between groups in EPIC scores., Conclusion: Supervised PFMT can improve postoperative UI and PFM function after RARP. Further studies are needed to confirm whether intra-anal pressure reflects PFM function and affects continence status in UI in men who have undergone RARP., (© 2024 BJU International.)

Background: Urinary incontinence (UI) is common among postpartum women, but many do not seek medical help due to limited knowledge. Understanding the level of knowledge about UI in this population is essential for improving care-seeking behaviors and implementing targeted interventions., Objective: The objective was to examine knowledge regarding UI among postpartum women with UI within 6 weeks to 1 year after delivery., Methods: A cross-sectional study was conducted at obstetric clinic in two level-three grade A hospitals in Shenzhen, China, from January 2023 to June 2023. Women in their 6 weeks to 1 year after delivery with UI were asked to complete a questionnaire comprising three sections: (1) demographic variable; (2) International Consultation on Incontinence Questionnaire Short Form (ICIQ-UI SF); and (3) The Urinary Incontinence Quiz (UIQ)., Results: A total of 1228 women completed the questionnaire. Their mean UIQ score was 6.63 ± 3.51 (minimum = 2, maximum = 15), indicating the deficiency of UI knowledge among Chinese postpartum women. A total of 86.4% of participants experienced slight or moderate postpartum UI. The results of multivariate linear regression models for UIQ reveal significant independent associations between questionnaire scores and two variables: experience in pelvic floor muscle training (PFMT) (p < 0.001) and UI treatment in the past (p < 0.001). The overall model fit was R 2  = 0.559 (p < 0.001). The regression coefficients for the experience in PFMT and UI treatment in the past were 2.301 and 4.916, respectively. However, no other discernible factors were identified to distinguish between those with and without adequate knowledge., Conclusions: Postpartum women with UI within 6 weeks to 1 year after delivery had poor knowledge of UI. Targeted educational interventions focusing on PFMT and early treatment for UI are essential., (© 2024 Wiley Periodicals LLC.)

Background: Gestational diabetes mellitus (GDM) is a common metabolic disease that contributes to urinary incontinence (UI) in pregnant women. The aim of this study was to investigate the therapeutic potential of stable pelvic floor muscle (PFM) training with transverse abdominal muscle for pregnancy-specific UI in patients with GDM., Methods: This was a randomised controlled trial. A total of 73 pregnant women with GDM and pregnancy-specific UI were screened, 35 of whom received stable PFM training with transverse abdominal muscle in the second trimester. After six weeks of training, UI status was assessed by the quantity of fluid loss and the International Consultation on Incontinence Questionnaire short form (ICI-Q-SF), and the quality of life was evaluated by the Incontinence Quality of Life Questionnaire score. Additionally, the thickness of the transverse abdominal muscle was measured by ultrasonography., Results: At 6 weeks later, the quantity of fluid loss and ICI-Q-SF score were significantly lower, and the overall healing rate was significantly higher in the training group than those in the control group. The training also significantly improved the quality of life, especially in terms of behavioural limitation and psychosocial impact. Additionally, the thickness of transverse abdominal muscle under the status of maximal contractions of transverse abdominal muscle and PFM was significantly higher in the training group than in the control group after 6 weeks., Conclusions: Stable PMF training with transverse abdominal muscle alleviated UI and improved the quality of life in patients with GDM. The thickening of transverse abdominal muscle induced by the training contributes to the remission of UI through the cooperation of PMF.

Introduction: The objective was to determine the relationship between sarcopenia and urinary dysfunction in patients with dysphagia., Material and Methods: A cross-sectional study was conducted on 460 Japanese Sarcopenic Dysphagia Database participants. Urinary dysfunction was defined as either urinary incontinence or urethral catheter use. Sarcopenia was diagnosed according to the Asian Working Group for Sarcopenia 2019 criteria. Univariate and multivariate analyses assessed the association between urinary dysfunction and sarcopenia, calf circumference (CC), handgrip strength (HGS), and Barthel Index (BI). Logistic regression analysis was performed for urinary dysfunction adjusted for age, sex, setting, and CCI in addition to BI and HGS or CC or sarcopenia (model 1) or FILS and BI (model 2)., Results: The mean age was 80.8 ± 10.5 years and urinary dysfunction in 137 participants. Urinary dysfunction was not associated with sarcopenia (123 versus 281, p = 0.440) but was associated with CC (27.4 ± 4.2 versus 28.5 ± 3.9, p = 0.009), HGS (9.7 ± 7.9 versus 14.4 ± 9.3, p < 0.001), and BI (19.9 ± 0.3 versus 20.3 ± 0.2, p < 0.001). Logistic regression analysis showed urinary dysfunction was associated with HGS (OR: 0.968, CI: 0.938, 0.998) and BI (OR: 0.955, CI: 0.943, 0.966). The cutoff was 19 kg for men (sensitivity 0.786, specificity 0.56, Area Under Curve (AUC) 0.689) and 6.1 kg for women (sensitivity 0.493, specificity 0.774, AUC 0.639) in HGS and 27.5 points in BI (sensitivity 0.781, specificity 0.604, AUC 0.740)., Conclusion: Sarcopenia was not associated with urinary dysfunction. However, HGS and BI were related to urinary dysfunction., Competing Interests: Declaration of competing interest All authors declare no competing of interest., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Objective: To explore the predictive value of preoperative pelvic floor electromyography (EMG) parameters for the risk of urinary incontinence after prostate cancer surgery., Methods: This study retrospectively analyzed the medical records of 271 patients who underwent radical prostatectomy in the urology department of Peking University First Hospital from January 2020 to October 2022. The data included patient age, body mass index (BMI), international prostate symptom score (IPSS), prostate-specific antigen (PSA) levels, Gleason score, type of surgery, urethral reconstruction, lymph node dissection, nerve preservation, catheterization duration, D ' Amico risk classification, American Society of Anesthesiologists (ASA) score, Charlson comorbidity index, postoperative duration, prostate volume, and pelvic floor EMG parameters (pre-resting mean, fast muscle mean, and slow muscle mean scores). Independent risk factors affecting early postoperative urinary incontinence were identified through multivariate Logistic regression analysis. The predictive efficacy of pelvic floor EMG results was evaluated by calculating the area under the receiver operating characteristic (ROC) curve, and the optimal threshold for early postoperative urinary incontinence was determined based on the Youden index and clinical significance., Results: The study included 271 prostate cancer patients, with an 81.9% rate of voluntary urinary control post-surgery. The median score for fast pelvic floor muscles was 23.5(18.2, 31.6), and for slow muscles, it was 12.5(9.6, 17.3). Among the patients, 179 (66.1%) did not preserve nerves, and 110 (40.6%) underwent urethral reconstruction. Advanced age and low fast muscle scores were identified as independent risk factors for urinary incontinence. Patients aged ≤60 had 5.482 times the voluntary urinary control rate compared with those aged ≥70 (95% CI : 1.532-19.617, P < 0.05). There was a significant correlation between fast muscle scores and urinary incontinence recovery ( OR =1.209, 95% CI : 1.132-1.291, P < 0.05). When the optimal threshold for preoperative fast muscle score was set at 18.5, the ROC sensitivity and specificity were 80.6% and 61.2%, respectively., Conclusion: Preoperative pelvic floor EMG parameters show good predictive accuracy and clinical applicability for the risk of urinary incontinence after prostate cancer surgery. These parameters can be used for early identification of urinary incontinence risk, with age and fast muscle scores being important predictors.

Objective: To evaluate the effectiveness of pelvic floor muscle training (PFMT) on pelvic floor muscle (PFM) function and quality of life (QoL) in women with stress urinary incontinence (SUI) and pelvic organ prolapse (POP)., Methods: This study will be a randomized, controlled, parallel, and blinded clinical trial. The final sample will consist of 32 women diagnosed with SUI and cystocele (stage I and II). All volunteers will be assessed and reassessed using the same protocol: assessment form, gynecological examination, functional evaluation of PFM, and questionnaires to assess quality of life, urinary function, and sexual function. All volunteers will be evaluated for satisfaction levels post-treatment. The intervention will be PFMT, totaling 16 sessions to be conducted twice a week. Reevaluation will take place at the end of treatment and 1 month after completion of PFMT. Descriptive analysis and repeated measures ANOVA will be used for result analysis. A significance level of p<0.05 will be considered for all statistical tests., Ethics and Dissemination: This study has been submitted to the Ethics in Research Committee of the Federal University of Rio Grande do Norte and approved under protocol number 5.826.563. It has been registered with the Brazilian Clinical Trials Registry ReBec (RBR-49p6g3t). It is expected that these studies will provide a deeper understanding of the efficacy of PFMT in women with SUI and cystocele. Additionally, it aims to provide more insights into the efficacy of PFMT prior to surgery., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 de Carvalho et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Although urinary incontinence in stroke survivors can substantially impact the patient's quality of life, the underlying neuropsychological mechanisms and its neural basis have not been adequately investigated. Therefore, we investigated this topic via neuropsychological assessment and neuroimaging in a cross-sectional study., Methods: We recruited 71 individuals with cerebrovascular disease. The relationship between urinary incontinence and neuropsychological indices was investigated using simple linear regression analysis or Mann-Whitney U test, along with other explanatory variables, e.g., severity of overactive bladder. Variables with a p-value of <0.1 in the simple regression analysis were entered in the final multiple linear regression model to control for potential confounding factors. To carry out an in-depth examination of the neuroanatomical substrate for urinary incontinence, voxel-based lesion-behavior mapping was performed using MRIcron software., Results: Behavioral control deficits and severity of overactive bladder were closely related to severity of urinary incontinence. The voxel-based lesion-behavior mapping suggests a potential role for ventromedial prefrontal cortex lesioning in the severity of urinary incontinence, although this association is not statistically significant., Conclusions: Post-stroke urinary incontinence is closely related to two factors: neurogenic overactive bladder, a physiological disinhibition of micturition reflex, and cognitive dysfunction, characterized by behavior control deficits., Competing Interests: Declaration of competing interest There are no conflicts of interest., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Urinary incontinence is a common complication in stroke survivors for whom new interventions are needed. This study investigated the therapeutic effect of low-frequency (LF) repeated transcranial magnetic stimulation (rTMS) on the contralesional primary motor cortex (M1) in patients with poststroke urinary incontinence (PSI). A total of 100 patients were randomly assigned to the rTMS group or sham-rTMS group on basis of the intervention they received. Both groups underwent five treatment sessions per week for 4 weeks. Data from the urodynamic examination were used as the primary outcome. The secondary outcome measures were questionnaires and pelvic floor surface electromyography. After 4 weeks of intervention, the maximum cystometric capacity (MCC), maximum detrusor pressure (Pdet.max), residual urine output, overactive bladder score (OABSS) (including frequency, urgency, and urgency urinary incontinence), and the ICIQ-UI SF improved significantly in the rTMS group compared with those in the sham-rTMS group (P < 0.05). However, no changes in pelvic floor muscle EMG were detected in patients with PSI (both P > 0.05). Our data confirmed that 4 weeks of LF-rTMS stimulation on the contralateral M1 positively affects poststroke urinary incontinence in several aspects, such as frequency, urgency urinary incontinence, MCC, end-filling Pdet, OABSS, and ICIQ-UI SF scores., (© 2024. The Author(s).)

Background: Vaginal laxity (VL) is a complaint of excessive vaginal looseness with a prevalence ranging from 24% to 38% across studies., Aim: The study sought to compare the effect of radiofrequency (RF) and pelvic floor muscle training (PFMT) on the treatment of women with VL., Methods: From February 2020 to December 2021, a prospective, parallel, noninferiority, randomized clinical trial was carried out in women ≥18 years of age and complaining of VL in a tertiary hospital. Two groups (RF and PFMT) were evaluated at the beginning of the study and 30 days and 6 months postintervention. A total of 42 participants per arm was sufficient to demonstrate a difference in sexual function on the Female Sexual Function Index at 90% power, 1-sided type 1 error of 0.025 with a noninferiority margin of 4 on the FSFI total score. Analysis was intention-to-treat and per-protocol based., Outcomes: The primary endpoint was the change of FSFI score after treatment, and the secondary outcomes were improvement in symptoms of VL and changes in questionnaire scores of sexual distress, vaginal symptoms, and urinary incontinence, in the quantification of pelvic organ prolapse, and pelvic floor muscle (PFM) contraction., Results: Of 167 participants recruited, 87 were included (RF: n = 42; PFMT: n = 45). All questionnaires improved (P < .05) their total scores and subscales in both groups and during the follow-ups. After 30 days of treatment, RF was noninferior to PFMT to improving FSFI total score (mean difference -0.08 [95% confidence interval, -2.58 to 2.42]) in the per-protocol analysis (mean difference -0.46 [95% confidence interval, -2.92 to 1.99]) and in the intention-to-treat analysis; however, this result was not maintained after 6 months of treatment. PFM contraction improved significantly in both groups (RF: P = .006, 30 days; P = .049, 6 months; PFMT: P < .001, 30 days and 6 months), with better results in the PFMT group., Clinical Implications: Sexual, vaginal, and urinary symptoms were improved after 30 days and 6 months of treatment with RF and PFMT; however, better results were observed in the PFMT group after 6 months., Strengths & Limitations: The present randomized clinical trial used several validated questionnaires evaluating quality of life, sexual function and urinary symptoms, in addition to assessing PFM contraction and classifying the quantification of pelvic organ prolapse aiming at anatomical changes in two follow-up periods. The limitations were the lack of a sham-controlled group (third arm) and the difficulty of blinding researchers to assess treatments due to the COVID-19 pandemic., Conclusion: After 30 days and 6 months of treatment, sexual, vaginal, and urinary symptoms improved with RF and PFMT; however, better results were observed in the PFMT group after 6 months. RF was noninferior to PFMT in improving FSFI total score after 30 days; however, this result was not maintained after 6 months of treatment., (© The Author(s) 2024. Published by Oxford University Press on behalf of The International Society of Sexual Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Introduction: A "Think Tank" at the International Consultation on Incontinence-Research Society meeting held in Bristol, United Kingdom in June 2023 considered the progress and promise of machine learning (ML) applied to urodynamic data., Methods: Examples of the use of ML applied to data from uroflowmetry, pressure flow studies and imaging were presented. The advantages and limitations of ML were considered. Recommendations made during the subsequent debate for research studies were recorded., Results: ML analysis holds great promise for the kind of data generated in urodynamic studies. To date, ML techniques have not yet achieved sufficient accuracy for routine diagnostic application. Potential approaches that can improve the use of ML were agreed and research questions were proposed., Conclusions: ML is well suited to the analysis of urodynamic data, but results to date have not achieved clinical utility. It is considered likely that further research can improve the analysis of the large, multifactorial data sets generated by urodynamic clinics, and improve to some extent data pattern recognition that is currently subject to observer error and artefactual noise., (© 2023 Wiley Periodicals LLC.)

Background: Bladder diaries represent a fundamental component in the assessment of patients presenting with lower urinary tract symptoms. Nevertheless, their importance often remains underappreciated and undervalued within clinical practice. This paper aims to conduct a comprehensive review of the existing literature concerning the utility of bladder diaries, underscore the criticality of their precision, elucidate the factors contributing to noncompliance with bladder diary completion, and investigate potential strategies for enhancing patient compliance., Materials and Methods: A review of the English-language scientific literature available in the domains of Medline, Embase, Emcare, Midirs, and Cinahl was conducted. This was supplemented by discussion at the International Consultation on Incontinence Research Society Proposal session to define knowledge and identify gaps in knowledge surrounding the utility of bladder diaries. The existing evidence and outcome of the relevant discussion held in the meeting are presented., Results: Bladder diaries (BD) serve to characterize the nature and severity of storage lower urinary tract symptoms (LUTS) and provide an objective record of an individual's urination patterns. They aid in the refinement and customization of treatment strategies based on the clinical responses documented in the diary, optimizing treatment outcomes. Notably, both BD and urodynamic studies (UDS) play complementary yet distinct roles in LUTS evaluation. BD offers a more comprehensive and accessible approach to assessing specific storage LUTS, particularly due to their affordability and widespread availability, especially in resource-limited settings. Nevertheless, the absence of a standardized BD format across global healthcare systems presents a significant challenge. Despite being recognized as reliable, noninvasive, validated, and cost-effective tools for evaluating patients with LUTS, the implementation and completion of BD have proven to be complex. The introduction of automated bladder diaries heralds an era of precise, real-time data collection, potentially enhancing the patient-clinician relationship. Completion of bladder diaries depends on an array of individual, social, and healthcare-specific factors. Compliance with bladder diary completion could be enhanced with clear instructions, patient education, regular follow-ups and positive re-enforcement. This study has identified four critical areas for future research: Addressing healthcare disparities between affluent and developing nations, enhancing the current functionality and effectiveness of bladder diaries, exploring the feasibility of incorporating bladder diaries into the treatment and education process and improving the quality and functionality of existing bladder diaries., Conclusion: Bladder diaries play a pivotal role in the evaluation and management of patients with LUTS, providing a holistic perspective. When their complete potential is harnessed, they have the capacity to revolutionize the paradigm of LUTS management, ushering in a patient-centered era of care., (© 2023 Wiley Periodicals LLC.)

Background: Bladder training (BT), the maintenance of a scheduled voiding regime at gradually adjusted intervals, is a common treatment for overactive bladder (OAB)., Objectives: To assess the effects of isolated BT and/or in combination with other therapies on OAB symptoms., Methods: A systematic review of eight databases was conducted. After screening titles and abstracts, full texts were retrieved. Cochrane RoB 2 and the GRADE approach were used., Results: Fourteen RCTs were included: they studied isolated BT (n = 11), BT plus drug treatment (DT; n = 5), BT plus intravaginal electrical stimulation (IVES; n = 2), BT plus biofeedback and IVES (n = 1), BT plus pelvic floor muscle training and behavioral therapy (n = 2), BT plus percutaneous tibial nerve stimulation, and BT plus transcutaneous tibial nerve stimulation (n = 1). In a meta-analysis of short-term follow-up data, BT plus IVES resulted in greater improvement in nocturia (mean difference [MD]: 0.89, 95% CI: 0.5, 1.20), urinary incontinence (UI; MD: 1.93, 95% CI: 1.32, 2.55), and quality of life (QoL; MD: 4.87, 95% CI: 2.24, 7.50) than isolated BT, while DT and BT improved UI (MD: 0.58, 95% CI: 0.23, 0.92) more than isolated BT., Conclusion: In the short term, BT plus IVES improves the OAB symptoms of nocturia and UI while improving QoL. The limited number of RCTs and heterogeneity among them provide a low level of evidence, making the effect of BT on OAB inconclusive, which suggests that new RCTs should be performed., Competing Interests: Conflict of interest The authors declare no conflicts of interest., (Copyright © 2024 Associação Brasileira de Pesquisa e Pós-Graduação em Fisioterapia. Publicado por Elsevier España, S.L.U. All rights reserved.)

Background/aim: Distal extremity misalignment may give rise to pelvic floor dysfunctions (PFDs). This study aimed to compare pelvic floor muscle strength (PFMS) and dysfunctions in women with and without pes planus., Materials and Methods: Women with (pes planus group, n = 30) and without pes planus (control group, n = 30) were included. The presence of PFDs questioned. Pes planus with the Feiss Line Test, PFMS with the Modified Oxford Scale, and the severity of PFDs with the Pelvic Floor Distress Inventory-20 (PFDI-20), including three subscales (Pelvic Organ Distress Inventory-6 (POPDI-6) for pelvic organ prolapse, Colorectal-Anal Distress Inventory-8 (CRADI-8) for colorecto-anal symptoms, and Urinary Distress Inventory-6 (UDI-6) for urinary symptoms, were assessed., Results: It was seen that no difference was found between groups in terms of PFMS (p > 0.05). However, urinary incontinence and anal incontinence were higher in women with pes planus than in women without pes planus (p < 0.05). Only the PFDI-20, CRADI-8, and UDI-6 scores were higher in women with pes planus compared to controls (p < 0.05). There was no difference was found between groups in terms of POPDI-6 scores (p > 0.05)., Conclusion: The PFMS did not change according to the presence of pes planus. However, the prevalence of PFDs and their severity were higher in women with pes planus in comparison to controls. Posture assessments of individuals with PFDs, especially examination of foot posture, and pelvic floor assessments of individuals with posture disorders should be considered., Competing Interests: Declaration of competing interest Author TOPRAK CELENAY, Author YARDIMCI, and Author ALTAY declare that they have no conflict of interest., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Objectives: This study evaluated patients with occult spinal dysraphism who underwent spinal cord untethering., Methods: Twenty-four patients who visited us between 1983 and 2000 were followed-up for a mean duration of 31 years. We studied their lower urinary tract function, skin stigmata, fertility, and work participation., Results: Questionnaires sent in 2022 revealed that 5 patients had normal voiding (Group A) and 19 patients had abnormal voiding (Group B). Groups A and B underwent spinal cord untethering at a mean age of 5.7 and 13.0 years, respectively, showing a significant statistical difference (p = 0.036). After spinal cord untethering, the number of patients with detrusor normoactivity increased from 0 to 5, i.e., 3 of 6 with detrusor overactivity (50%), 1 of 2 not examined, and 1 of 5 not known. Patients with detrusor underactivity also increased from 11 to 19. Severity of incontinence in the International Consultation on Incontinence Questionnaire-Short Form resulted in a mean value of 2.4 in Group A, which was significantly superior to the mean value of 9.1 in Group B (p = 0.004). Fourteen patients (58.3%) were married and had 21 healthy children. A majority of patients have had full-time jobs. A variety of skin stigmata were present in the lumbosacral region, and changes in vesico-urethral configurations were observed during a video-urodynamic study., Conclusions: Our study identified that the early timing of spinal cord untethering performed in neonates or infants and detrusor overactivity prior to untethering surgery are important factors in achieving normal bladder function., (© 2024 The Japanese Urological Association.)

Introduction and Hypothesis: The aim is to compare the effects of the progressive training program (PTP), a new protocol, with two different hybrid telerehabilitation methods, on the parameters related to urinary incontinence in women with urinary incontinence., Methods: A total of 50 participants with stress or mixed urinary incontinence participated in this two-arm, parallel-group, randomized, non-inferiority trial. Individual hybrid training (IHT) or group hybrid training (GHT) was given to women for 8 weeks. The Power, Endurance, Repetitions, Fast contractions, and Every Contraction Timed (PERFECT) scheme and surface electromyography were used to assess pelvic floor muscle function, whereas quality of life, exercise adherence, and symptoms were assessed by questionnaires and a 3-day bladder diary. An intention-to-treat analysis was performed. Linear mixed model analysis with the factors "time" and "group" was used to determine the effects of IHT and GHT., Results: The primary outcome was changes in pelvic floor muscle function as evaluated using the PERFECT scheme and surface electromyography at the 4th and 8th weeks relative to baseline. No statistical difference was found between the groups except for "power" of the PERFECT scheme and "nocturnal urination frequency" (p > 0.05). The GHT showed significant improvement in P and nocturnal urination frequency at the end of the 8th week (p < 0.05). From baseline to week 8, the effect size for the P value was found to be small (Cohen's d = 0.33)., Conclusion: Eight weeks of PTP did not lead to different results in incontinence-related parameters in either of the training methods. It may be better to conduct GHT in terms of implementing PTP in incontinence and training programs in terms of time, staff workload, and applicability., (© 2024. The International Urogynecological Association.)

In this review, current understanding of the prevention and treatment of Incontinence Associated Dermatitis (IAD) is discussed. The need for preventative measures which target specific faecal/urinary irritants is highlighted, including the role of urease inhibitors. There is no existing internationally and clinically accepted method to diagnose and categorise the severity of IAD. Diagnosis currently relies on visual inspection; non-invasive techniques to assess skin barrier function could remove subjectiveness, particularly in darker skin tones. Impedance spectroscopy is a non-invasive technique which can be used to monitor skin barrier function, supporting visual assessments. Six studies (2003-2021) which used impedance to assess dermatitis were reviewed; inflamed skin was distinguishable from healthy skin in each case. This suggests that impedance spectroscopy could be useful in diagnosis early-stage IAD, potentially enabling earlier intervention. Finally, the authors present their initial findings on the role of urease in skin breakdown in an in vivo IAD model, using impedance spectroscopy., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Type 1 diabetes increases the prevalence of urinary incontinence and may be responsible for additional changes to those existing in a regular gestational period. This study aimed to describe the presence and symptoms of urinary incontinence in pregnant women with type 1 diabetes., Methods: In this Cross-sectional case control study, forty pregnant women in third gestational trimester were allocated in two equal groups - control group (CG) and type 1 diabetic group (1DMG). The patients answered the International Consultation on Incontinence Questionnaire Short Form and, to characterize the sample, they answered the Pregnancy Physical Activity Questionnaire, gynecological history and, after delivery, the newborn weight was registered. The groups were compared using the Student's T Test for parametric variables and the U-Mann Whitney Test for non-parametric variables, both at 5% probability., Results: The International Consultation on Incontinence Questionnaire Short Form score (p = 0.026) is higher in 1DMG (3.95 ± 4.70) compared to CG (1.05 ± 2.23). No correlations were found between time of diagnosis, HbA1c and newborn weight in relation to ICIQ-SF and other variables in CG and 1DMG with ICIQ-SF (p < 0.05)., Conclusion: Type 1 diabetes mellitus, in the third trimester of gestation, seem to be associated with increase in the ICIQ-SF score., (© 2024. The Author(s), under exclusive licence to Society for Reproductive Investigation.)

The International Consultation on Incontinence (ICI) captures current evidence on incontinence. The conference 'Incontinence: The Engineering Challenge XIII' in November 2021 heard an update on the most recent ICI summary on urodynamic testing. This paper summarises the ICI recommendations for future research in urodynamics, with a view to informing engineers of issues and challenges that could benefit from engineering solutions. Engineers are encouraged to contribute to the following areas of research, which will have a direct and positive effect on patients' quality of life and overall health: (a) Urine flow measurement: home- and app-based devices, machine learning analysis of flow shape, (b) Pressure measurement: normal values for and validation of new technologies, including air-filled, non-invasive and urethral pressure reflectometry, (c) Ultrasound imaging: bladder wall biomechanics, bladder shape analysis, (d) Assess normal and abnormal value ranges, and diagnostic performance and (e) Specific trials in understudied patient groups including those with symptoms resistant to treatment, children and the frail elderly., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Giggle incontinence (GI) is poorly described, defined, and understood. It is considered a bladder storage disorder in which laughter causes an uncontrollable episode of urinary incontinence that cannot be stopped until the bladder is completely emptied. It has been confused with stress urinary incontinence and overactive bladder. A thorough analysis of 26 articles on the subject of "giggle incontinence" and associated terms was performed, including all articles since the phrase first appeared. To date, 351 GI cases have been reported. It occurs mainly in women (69.5%) at 5 years of age, with a prevalence ranging from 8.4 to 16.2 years (average age of 12.4 years), and some cases have a family history of the disease (13-16.7%). This review discusses the historical background, current understanding, and challenges related to GI. It primarily affects females after the age of 5 years, causing complete bladder emptying during uncontrollable laughter. The exact cause is unknown, but hypotheses suggest involvement of the central nervous system. Diagnosis relies on clinical history, physical tests, and urine frequency evaluation. Management involves urotherapy techniques, biofeedback, and methylphenidate. Understanding GI will aid in developing more effective management techniques. IMPACT: Highlights limited awareness among healthcare professionals about giggle incontinence as a distinct condition, emphasizing the need for standardized diagnostic criteria and assessment tools. Addresses insufficient understanding of the underlying mechanisms and contributing factors, providing valuable insights for better diagnosis and treatment. Emphasizes the importance of patient education and support, calling for improved resources and counseling. Urges further research and evidence-based guidelines to enhance treatment strategies., (© 2024. The Author(s), under exclusive licence to the International Pediatric Research Foundation, Inc.)

Stress urinary incontinence often results from pelvic support structures' weakening or damage. This dysfunction is related to direct injury of the pelvic organ's muscular, ligamentous or connective tissue structures due to aging, vaginal delivery or increase of the intra-abdominal pressure, for example, defecation or due to obesity. Mechanical changes alter the soft tissues' microstructural composition and therefore may affect their biomechanical properties. This study focuses on adapting an inverse finite element analysis to estimate the in vivo bladder's biomechanical properties of two groups of women (continent group (G1) and incontinent group (G2)). These properties were estimated based on MRI, by comparing measurement of the bladder neck's displacements during dynamic MRI acquired in Valsalva maneuver with the results from inverse analysis. For G2, the intra-abdominal pressure was adjusted after applying a 95% impairment to the supporting structures. The material parameters were estimated for the two groups using the Ogden hyperelastic constitutive model. Finite element analysis results showed that the bladder tissue of women with stress urinary incontinence have the highest stiffness (α 1  = 0.202 MPa and µ 1  = 7.720 MPa) approximately 47% higher when compared to continent women. According to the bladder neck's supero-inferior displacement measured in the MRI, the intra-abdominal pressure values were adjusted for the G2, presenting a difference of 20% (4.0 kPa for G1 and 5.0 kPa for G2). The knowledge of the pelvic structures' biomechanical properties, through this non-invasive methodology, can be crucial in the choice of the synthetic mesh to treat dysfunction when considering personalized options., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Frailty is associated with urinary and fecal incontinence, which are common geriatric syndromes. This study aims to identify health factors associated with incontinence in prefrail or frail older adults living in the community., Methods: This multicenter cross-sectional study included 225 older adults (75.0 ± 6.4 years) with prefrailty or frailty based on the 5-component Fried phenotype. Physical function was assessed using the Short Physical Performance Battery (SPPB). Physical activity, inactivity, and sleep were estimated using a wrist-worn accelerometer. Urinary or fecal incontinence was registered using the Barthel scale (urine and bowel items). Multivariable logistic regression analyses, with age as a covariate, were conducted to identify associations of incontinence., Results: In our participants, 27% presented urinary or fecal incontinence with no sex differences (p = .266). Our results showed that age, daily medication count, and number of falls in the previous year independently predicted incontinence in frail and prefrail older adults (p < .05). Some Fried's criteria, including self-reported exhaustion, gait speed, and handgrip strength, were associated with the presence of incontinence (p < .05), but not Fried's classification. The SPPB total score and its isolated variables were significantly associated with the urinary and fecal incontinence (p < .05). However, none of the accelerometer outcomes showed significant associations with incontinence status., Conclusions: According to this study, age, number of medications, and falls (but not sex) are linked to urinary and fecal incontinence in frail or prefrail older adults living in the community, recommending the assessment of physical function using the SPPB rather than estimating daily physical activity, inactivity, or sleep., (© The Author(s) 2024. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Background: The accuracy of self-reported urinary incontinence (UI) and fecal incontinence (FI) among adults with spina bifida (SB) is unknown. We aimed to quantify the accuracy of self-reported recall incontinence in the last 4 weeks using prospective diary data., Methods: Adults with SB were enrolled via patient advocacy groups in a larger 30-day smartphone-based ecological momentary assessment study of daily well-being and incontinence. We examined agreement between yes/no questions on exit questionnaires ("In the last 4 weeks, did you leak any urine and get your underwear, pads, pull-ups or disposable underwear wet?") and 30-day diaries. Collected data included a non-validated 4-item UI Negativity scale (UIN: 0-100, 0 = no impact). Inter-rater reliability was assessed with Cohen's kappa (>0.60 = substantial). FI was analyzed similarly. Sub-groups were too small for statistical analysis., Results: Median age of 88 adults was 35 years old (70% female, 53% shunted, 71% community ambulators). Among 81 adults reporting UI in the last month, 79 (98%) had diary-documented UI (UI agreement), 2 (2%) did not (Summary Table). Among 7 adults reporting no UI in the last month, 5 (71%) did not record UI in their diaries (agreement in no UI), 2 (29%) did. Both adults reporting no UI on exit questionnaires, despite contrary diary data, experienced single UI episodes (negativity: 0 and 6). In contrast, the UI agreement group recorded UI on median 18 days (median negativity: 22). Sensitivity of the recall UI question was 0.98 (specificity 0.71, kappa 0.69). Among 66 adults reporting FI in the last month, 65 (98%) had diary-documented FI (FI agreement), 1 (2%) did not. Among 22 adults reporting no FI in the last month, 17 (77%) did not record FI in their diaries (agreement in no FI), 5 (23%) did. Five adults reporting no FI on exit questionnaires, despite contrary diary data, experienced a median single episode (median negativity: 8). In contrast, the FI agreement group recorded FI on median 5 days (median negativity: 31). Sensitivity of the recall FI question was 0.93 (specificity 0.94, kappa 0.81). Results were unchanged when analyzing the first and last 28 days of data., Comment: Sensitivity/specificity of single incontinence questions approach those reported for women with UI but without SB. Diaries may best serve SB adults with bothersome incontinence., Conclusions: Self-reported incontinence accurately and reliably captures UI and FI among adults with SB. It may minimize less bothersome incontinence, supporting its use in screening for clinical practice and research., Competing Interests: Conflicts of interest Dr. Hensel is a paid research consultant with For Goodness Sake, LLC., (Copyright © 2024 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.)

Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Incontinence and toileting difficulties can often be successfully addressed by treating their underlying causes. However, (complete) cure is not always possible and continence products to prevent or contain unresolved leakage or to facilitate toileting are in widespread use. Many people use them successfully but identifying the product(s) most likely to meet individual needs can be challenging and the recently published Seventh International Consultation on Incontinence includes a chapter which draws on the literature to provide evidence-based recommendations to help clinicians and product users to select appropriate products. This paper is based on the same evidence, but reviewed from the different perspective of those keen to identify unmet needs and develop improved products. For each of the main continence product categories it (i) outlines the design approach and key features of what is currently available; (ii) provides a generic functional design specification; (iii) reviews how well existing products meet the requirements of their main user groups; and (iv) suggests priorities for the attention of product designers. It also flags some core scientific problems which - if successfully addressed - would likely yield benefits in multiple incontinence product contexts., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Educational and self-care measures are important for women after gynecological pelvic cancer treatment. Pelvic floor muscle training exercises (PFMT) are a conservative treatment for pelvic floor (PF) dysfunction. The purpose is to evaluate the impact of a telerehabilitation and self-care program on PF dysfunctions, reports of urinary incontinence (UI), and physical-emotional factors of participants post-treatment for gynecological pelvic cancer., Methods: Two-arm randomized clinical trial: an intervention group (IG) will evaluate the effect of a telerehabilitation program on women undergoing clinical practice of radiotherapy for the treatment of gynecological pelvic cancer and a control group (CG) will maintain the routine. Primary outcome is the prevalence of reports of UI, which will be assessed using the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF). The secondary outcomes will be the severity and impact of UI on quality of life, location and perception of pain intensity, presence and intensity of dyspareunia, vaginal stenosis, fecal incontinence (FI), and levels of physical activity. Statistical analysis will be performed by intention-to-treat, and multivariate mixed effects analysis will be used to compare results., Discussion: Activities in the context of telerehabilitation using PFMT and self-care can represent a viable and effective solution to minimize the side effects of gynecological cancer treatment and improve women's quality of life., (© 2024. The Author(s).)

Objective: To analyze the static and dynamic urodynamic parameters of reservoirs and continent conduits in continent cutaneous urinary diversion with catheterizable stoma., Materials and Methods: 76 patients had augmented ileocystoplasty or continent urinary diversion with catheterizable urinary stoma based on Mitrofanoff principle and Yang-Monti procedure using subserous tunnel as continence mechanism. They were followed up for at least 6 months post-operatively for continence through stoma and divided into two groups (continents vs non-continent) according to stomal continence. Both groups had urodynamic assessment performed via the stoma to assess reservoir capacity, pressure and contractions, efferent limb functional length, reservoir overactivity, static and dynamic maximal closure pressures and leak point pressure., Results: Continence rate was 87%. Continent group included 66 patients and incontinent group included 10 patients. In both groups at rest, the reservoir pressure after filling did not exceed 25 cm H2O. During peristaltic contraction, the pressure did not exceed 30 cm H2O and the duct remained continent. After Valsalva maneuver, the reservoir pressure increased up to 34 (+ 7.4) cm H2O and leakage occur in 10 patients (13%). Reservoir (wall) overactivity was recorded in 54 patients, with insignificant rise in intraluminal pressure during the contractions. In both groups, the efferent tract closing pressure was always higher than the reservoir pressure. The mean of maximal closing pressure at Valsalva was 82.5 (+ 4.18) cm H2O in the continent group and 61.66 (+ 8.16) cm H2O in the incontinent group. The mean functional length of the conduit was 4.95 + 1.62 in the continent group and 2.80 + 1.50 cm in the incontinent group., Conclusions: Urodynamic evaluation of continent catheterizable cutaneous stoma after Yang-Monti procedure has a practical significance. Functional length of the conduit seems to be the most influential factor for continence reflecting static & dynamic maximal closure pressure. Higher conduit closing pressure is associated with better continence. Contractions of the pouch and peristaltic contraction of the conduit has no effect on continence mechanism.

As the Japanese population continues to age steadily, the number of older adults requiring healthcare has increased. Evidence demonstrates that hospitalization for acute care has a negative impact on the health outcomes of older adults. Frail older adults tend to have multifactorial conditions collectively known as "geriatric syndromes." When those with these premorbid conditions are hospitalized for acute care, they tend to develop new problems such as delirium and new functional impairments. Adverse consequences of hospitalization include the risk of loss of functional independence and chronic disability. In 2019, the new concept of "hospital-associated complications" (HACs) was proposed to describe these new problems. HACs comprise five conditions: hospital-associated falls, delirium, functional decline, incontinence, and pressure injuries. This review discusses the important issues of HACs in relation to their classification, prevalence, risk factors, prevention, and management in older adults hospitalized for acute care. Robust prevention and management are imperative to address the serious consequences and escalating medical costs associated with HACs, and a multidimensional and multidisciplinary approach is key to achieving this goal. Comprehensive geriatric assessment (CGA) is the cornerstone of geriatric medicine and offers a holistic approach involving multidisciplinary and multidimensional assessments. Considerable evidence is accumulating regarding how CGA and coordinated care can improve the prognosis of hospitalized older adults. Further research is needed to understand the occurrence of HACs in this population and to develop effective preventive measures., Competing Interests: The author declares that there is no conflict of interest.

Background: Neurogenic bladder and bowel dysfunctions lead to physical, social, and emotional disability and affects one's quality of life. Initial treatment is conservative including several rehabilitation techniques such as pelvic floor muscle training, biofeedback, electrical stimulation, and posterior tibial nerve stimulation., Objective: In this case report, a 45-year-old woman with neurogenic bladder and bowel dysfunction was presented., Case Description: Her urinary and fecal incontinence symptoms began twenty years before this episode of care, after an incomplete spinal cord injury secondary to spinal ependymoma and syringomyelia. She discontinued medical treatments due to side effects and ceased intermittent catheterization. A multimodal pelvic rehabilitation program was administered consisting of posterior tibial nerve stimulation, active pelvic floor muscle training accompanied by biofeedback, and electrical stimulation of pelvic floor muscles., Outcomes: There were clinically important favorable differences in the scores of King's health questionnaire (reductions in symptom severity from 25 to 18 and in each of the impact of incontinence, physical and social limitations, personal relationships, sleep/energy, and severity measures from 100 to 67), pelvic floor distress inventory (decreased from 257 to 146) and female sexual function index (increased from 15.1 to 25.1) after 12 weeks of a multimodal pelvic rehabilitation program. Manual muscle tests demonstrated improvements in pelvic floor muscle strength and endurance., Conclusion: A 12-week multimodal pelvic rehabilitation program reduced urinary and fecal incontinence symptoms, together with improvements in her sexual life and alleviation of neuropathic pain.

Background: Urinary incontinence is highly prevalent in women while pelvic floor muscle training is recommended as the first-line therapy. However, the exact treatment regimen is poorly understood. Also, patients with pelvic floor muscle damage may have decreased muscle proprioception and cannot contract their muscles properly. Other conservative treatments including electromagnetic stimulation are suggested by several guidelines. Thus, the present study aims to compare the effectiveness of electromagnetic stimulation combined with pelvic floor muscle training as a conjunct treatment for urinary incontinence and different treatment frequencies will be investigated., Methods/design: This is a randomized, controlled clinical trial. We will include 165 patients with urinary incontinence from the outpatient center. Participants who meet the inclusion criteria will be randomly allocated to three groups: the pelvic floor muscle training group (active control group), the low-frequency electromagnetic stimulation group (group 1), and the high-frequency electromagnetic stimulation group (group 2). Both group 1 and group 2 will receive ten sessions of electromagnetic stimulation. Group 1 will be treated twice per week for 5 weeks while group 2 will receive 10 days of continuous treatment. The primary outcome is the change in International Consultation on Incontinence Questionnaire-Short Form cores after the ten sessions of the treatment, while the secondary outcomes include a 3-day bladder diary, pelvic floor muscle function, pelvic organ prolapse quantification, and quality of life assessed by SF-12. All the measurements will be assessed at baseline, after the intervention, and after 3 months of follow-up., Discussion: The present trial is designed to investigate the effects of a conjunct physiotherapy program for urinary incontinence in women. We hypothesize that this strategy is more effective than pelvic floor muscle training alone, and high-frequency electromagnetic stimulation will be superior to the low-frequency magnetic stimulation group., (© 2024. The Author(s).)

Introduction and Hypothesis: Urinary incontinence (UI) is prevalent among older women, but conservative treatment rates remain low due to limited accessibility, despite evidence supporting pelvic floor muscle training (PFMT) efficacy. Group-based approaches, including online options, could offer cost-effective alternatives. Recent evidence supports the feasibility of online group-based PFMT for treating UI in older women. This pilot study now evaluated the clinical effects of this program on the number of leakage episodes per day, additional UI-specific outcomes, and other symptoms and indicators., Methods: Community-dwelling women aged 65 and over, with stress or mixed UI, were recruited. Eligibility was assessed through in-person evaluations conducted by pelvic floor physiotherapists, who instructed participants on pelvic floor muscle contraction using digital palpation. Participants engaged in a 12-week group-based PFMT program with weekly 1-h sessions. Data were collected at three time points: recruitment (PRE1), before the first session (PRE2), and after the program (POST). Participants recorded UI symptoms using 7-day bladder diaries and standardized questionnaires on UI symptoms, quality of life (QoL), UI self-efficacy, and perceived costs. After the program (POST), participants provided feedback on their impression of improvement and satisfaction., Results: Participants reported a significant reduction in their number of leakage episodes per day. Standardized questionnaire scores also supported the positive effects of the program on UI symptoms and QoL, self-efficacy in avoiding leakage and performing PFMT exercises, and monthly costs for continence products. Older women expressed high satisfaction with symptom improvement and the program., Conclusions: Online group-based PFMT improved UI symptoms, QoL, UI self-efficacy, and perceived UI costs among older women. Pragmatic randomized controlled trials are necessary for further validation., (© 2024. The International Urogynecological Association.)

Background: The incidence of stroke in China ranks first in the world and is the leading cause of death and disability in adults. Urinary incontinence is an independent risk factor leading to poor prognosis of stroke. However, studies on the incidence of urinary incontinence in stroke patients and its influencing factors are different, fluctuate greatly, and there is no unified basis., Objective: To quantitatively analyze the incidence of urinary incontinence in stroke patients and its related influencing factors, and further make public health strategic decisions to reduce the occurrence of adverse outcomes., Methods: Computer searches were conducted in PubMed, Medline, Web of Science, Cochrane Library, Embase, CLNAHL Complete, China National Knowledge Infrastructure (CNKI), Chinese Biomedical database(CBM), Wan Fang Database, VIP Database, observational studies such as cohort studies, case-control studies or cross-sectional studies on the incidence or influencing factors of urinary incontinence in stroke patients from the establishment of the database to the publication in August 2023. Studies selection, quality evaluation and data extraction were conducted independently by two researchers according to the established search strategy. Stata 14.0 statistical software was used for meta-analysis., Results: A total of 21 manuscripts were included, with a cumulative sample size of 7327 cases, including 2887 patients with urinary incontinence. Meta-analysis results showed that the incidence of urinary incontinence in stroke patients was 38% [95% confidence interval (34%, 41%)], including married patients and lacunar infarction were the protective factors for urinary incontinence in stroke patients, while age, chaperone, low educational level, chronic cough, lesion sites (parietal lobe, frontal lobe, and temporal lobe), stroke type (cerebral hemorrhage, subarachnoid hemorrhage and cerebral hemorrhage complicated with subarachnoid hemorrhage), dysfunction (aphasia dyslexia, dysphagia, eye movement abnormalities, leg muscle disorders), post-stroke depression, the higher the NIHSS score, the lower the Bachmann index (BI) score, OCSP classification (total anterior circulation infarction) and other 11 items were risk factors for urinary incontinence in stroke patients., Conclusion: The incidence of urinary incontinence in stroke patients is 38%. Marriage and lacunar infarction are the protective factors of urinary incontinence. Age, carer, low educational level, chronic cough, lesion site (parietal, frontal and temporal lobes), stroke type (cerebral hemorrhage, subarachnoid hemorrhage, cerebral hemorrhage combined with subarachnoid hemorrhage), dysfunction (aphasia and dysarthria syndrome, dysphagia, eye movement abnormalities, leg muscle disorders), post-stroke depression, and higher NIHSS score, Lower BI score and OCSP classification (total anterior circulation infarction) were risk factors for urinary incontinence in stroke patients., (© 2024 Wiley Periodicals LLC.)

Introduction: Urinary incontinence (UI) affects over half of people with stroke. It is unclear which methods are accurate in assessing presence and type of UI to inform clinical management. Diagnosis of UI based on inaccurate methods may lead to unnecessary interventions. The aims of this systematic review were to identify, for adults with stroke, clinically accurate methods to determine the presence of UI and type of UI., Method: We searched seven electronic databases and additional conference proceedings. To be included, studies had to be primary research comparing two or more methods, or use a reference test., Results: We identified 3846 studies with eight eligible for inclusion. We identified 11 assessment methods within the eight studies. Only five studies had sufficient comparator data for synthesis. Due to heterogeneity of data, results on the following methods were narratively synthesized: Core Lower Urinary Tract Symptom Score (CLSS), clinical history and physical examination, Barthel Activities of Daily Living Index, International Consultation Incontinence Questionnaire Short Form (ICiQ-SF) and urodynamic studies (UDS). Most studies were small and of low to medium quality. All reported differences in sensitivity, and none compared the same assessment methods., Conclusion: Current evidence is insufficient to support recommendations on the most accurate UI assessment for adults with stroke. Further research is needed., (© 2023 The Authors. Neurourology and Urodynamics published by Wiley Periodicals LLC.)

Objectives: Urinary incontinence is pelvic floor muscles dysfunction, most often caused by a weakening of their strength. There are no guidelines on how to evaluate pelvic floor muscle function. Palpation is the most popular method of assessing pelvic floor muscle function, but it is subjective. The aim of the study was to review the objective methods used in the assessment of pelvic floor muscle function in women with urinary incontinence., Material and Methods: A systematic literature review of the PubMed database was performed using the following keywords: ["Pelvic Floor" (mh)] AND [("Pelvic Floor Disorders" (mh)] OR ["Urinary Incontinence" (mh)]. The search was limited to English-language works published from 2011 to 2021. The inclusion criteria were interventional studies in which the pelvic floor muscle function of women with urinary incontinence was assessed using quantitative tools. Methods that cannot be used in the clinic were excluded from the analysis., Results: Fifty-two articles were included in the analysis and five methods assessing the function of pelvic floor muscle were distinguished: manometry, electromyography (EMG), ultrasonography (USG), dynamometry, accelerometry., Conclusions: Manometry, EMG and USG are the most common objective methods of assessing pelvic floor muscle function. When taking measurements, it is important to choose the right position of the patient. The use of objective tools to assess the function of the pelvic floor muscle and obtaining quantitative and/or qualitative data allows us to precisely diagnose and monitor the treatment and rehabilitation progress.

Background: Aging and gender are risk factors for urine incontinence, which can lead to psychological, physical, and social complications., Objective: This community-based study investigates the effectiveness of pelvic floor muscle training on the severity and quality of urine incontinence and social participation of older women., Methods: This quasi-experimental community-based study was performed with the participation of 60 older women referring to the Public Health Center in Kerman City, southern Iran. The experiment group was trained with pelvic floor muscle training in 7 training sessions with distance health education in the second half of 2021. Before and after the intervention, data were collected based on: demographic, severity and quality of urine incontinence, and social participation inventories. Data were analyzed using a t-test and ANOVA (P ≤ 0.05)., Results: The mean scores of severity and quality of urine incontinence and social participation in the experiment and control groups before receiving the intervention were not statistically significant (P ≥ 0.05). But after that, a statistically significant difference was observed between the groups (P <0.05), which showed an improvement in the severity and quality of urine incontinence scores as well as SP in the experiment group., Conclusions: Tele-training of the Kegel exercise, even during the pandemic, can play an important role in improving incontinence and social participation in older women. Therefore, this training can be used to prevent and improve urine incontinence in public health centers in the community.

Background: Life-space mobility represents the distance, frequency, and independence of mobility, ranging from one's bedroom to beyond their town. Older men with lower urinary tract symptoms (LUTS) may limit their life-space to stay close to a bathroom. However, it's unknown whether LUTS severity or urinary bother are associated with risk of life-space mobility restriction., Methods: We analyzed data from 3025 community-dwelling men age ≥71 years without life-space mobility restriction at analytic baseline (Year 7) of the Osteoporotic Fractures in Men (MrOS) study. The American Urologic Association Symptom Index (AUASI) was assessed at baseline and includes one question assessing urinary bother ("If you were to spend the rest of your life with your urinary condition just the way it is now, how would you feel about that?"; score 0-1,2,3,4-6) and seven items to classify LUTS severity as none/mild (score 0-7), moderate (8-19), or severe (20-35). The University of Alabama Life-space Assessment was used to define life-space mobility restriction (≤60) at baseline and follow-up (Year 9). We used log-binomial regression with robust variance estimators to model adjusted risk ratios (ARR) for LUTS severity and urinary bother with incident life-space mobility restriction, controlling for age, site, health-related factors, and comorbidities. We then mutually adjusted for urinary bother and LUTS severity., Results: Overall, the 2-year risk of life-space mobility restrictions was 9.9%. Compared to men without urinary bother (scores 0-1), the risk of life-space mobility restriction was significantly higher among men with bother scores of 4-6 (ARR = 2.20, 95% CI: 1.52, 3.19), independent of LUTS severity and confounders. Conversely, LUTS severity was not independently associated with the risk of life-space mobility restriction., Conclusions: Urinary bother, but not LUTS severity, is independently associated with incident life-space mobility restriction among older men. To maintain life-space mobility in older men with LUTS, future studies should identify shared mechanisms and interventions that minimize urinary bother., (© 2022 The American Geriatrics Society.)

Objective: To investigate the association of urinary incontinence with depressive symptoms, and to explore the mediating effect of functional limitations on this association., Methods: This cross-sectional study included 7039 adults aged 50 and over from the English Longitudinal Study of Aging (Wave 8). Urinary incontinence was defined as whether the participants experienced urinary incontinence in the past 12 months. Depressive symptoms were assessed based on the Center for Epidemiologic Studies-Depression Scale. Functional limitations included disability of activities of daily living, instrumental activities of daily living, mobility and large muscle groups limitation of the participants. Logistic regression based on Karlson/Holm/Breen (KHB) method was applied to estimate the association of urinary incontinence with depressive symptoms and explore the mediating effect of functional limitations., Results: Urinary incontinence was significantly associated with increased risk of depressive symptoms after controlling covariates (odds ratio = 1.75, 95 % confidence interval: 1.45-2.11). Functional limitations explained 36.96 % of this association., Conclusion: Urinary incontinence might be associated with an increased risk of depressive symptoms among middle-aged and older adults and functional limitations partially mediate this association. Improving physically functional capacity might play an important role in preventing and managing depressive symptoms in elderly people with urinary incontinence., (Copyright © 2022. Published by Elsevier B.V.)