All Title Author
Keywords Abstract

Risk Factors for Urgency Incontinence in Women Undergoing Stress Urinary Incontinence Surgery

DOI: 10.1155/2013/567375

Full-Text   Cite this paper   Add to My Lib


Objective. To determine baseline variables associated with urgency urinary incontinence (UUI) in women presenting for stress urinary incontinence (SUI) surgery. Methods. Baseline data from two randomized trials enrolling 1,252 women were analyzed: SISTEr (fascial sling versus Burch colposuspension) and TOMUS (retropubic versus transobturator midurethral sling). Demographic data, POP-Q measures, and validated measures of symptom severity and quality of life were collected. Charlson Comorbidity Index (CCI) and Patient Health Questionnaire-9 were measured in TOMUS. Multivariate models were constructed with UUI and symptom severity as outcomes. Results. Over two-thirds of subjects reported bothersome UUI at baseline. TOMUS patients with more comorbidities had higher UDI irritative scores (CCI score 0 = 39.4, CCI score 1 = 42.1, and CCI score 2+ = 51.0, ), and higher depression scores were associated with more severe UUI. Smoking, parity, prior incontinence surgery/treatment, prolapse stage, and incontinence episode frequency were not independently associated with UUI. Conclusions. There were no modifiable risk factors identified for patient-reported UUI in women presenting for SUI surgery. However, the direct relationships between comorbidity level, depression, and worsening of UUI/urgency symptoms may represent targets for preoperative intervention. Further research is necessary to elucidate the pathophysiologic mechanisms that explain the associations between these medical conditions and bladder function. 1. Introduction The presence of stress urinary incontinence (SUI) or urgency urinary incontinence (UUI) has profound negative impacts on quality of life, exceeding that of other common morbid conditions such as diabetes [1]. However, women with both SUI and UUI—that is, mixed urinary incontinence (MUI)—have greater bother than those with SUI alone [2] and are less likely to have success or cure after undergoing surgical management of their SUI [3]. While multiple risk factors for worsening incontinence have been identified including age, parity, and body mass index [4], there is less known on whether other demographic variables, concurrent prolapse, or medical comorbidities may be associated with UUI in women presenting for surgical treatment of SUI. Better characterization of these associated variables may identify targets for intervention to improve outcomes and quality of life. This study is an ancillary analysis employing the databases of two large randomized trials of women presenting for surgical management of SUI: the Trial of Mid-Urethral Slings


[1]  Y. Ko, S.-J. Lin, J. W. Salmon, and M. S. Bron, “The impact of urinary incontinence on quality of life of the elderly,” American Journal of Managed Care, vol. 11, pp. S103–S111, 2005.
[2]  Y. Dooley, L. Lowenstein, K. Kenton, M. P. FitzGerald, and L. Brubaker, “Mixed incontinence is more bothersome than pure incontinence subtypes,” International Urogynecology Journal and Pelvic Floor Dysfunction, vol. 19, no. 10, pp. 1359–1362, 2008.
[3]  H. E. Richter, A. Diokno, K. Kenton et al., “Predictors of treatment failure 24 months after surgery for stress urinary incontinence,” Journal of Urology, vol. 179, no. 3, pp. 1024–1030, 2008.
[4]  P. S. Goode, K. L. Burgio, H. E. Richter, and A. D. Markland, “Incontinence in older women,” Journal of the American Medical Association, vol. 303, no. 21, pp. 2172–2181, 2010.
[5]  H. E. Richter, M. E. Albo, H. M. Zyczynski et al., “Retropubic versus transobturator midurethral slings for stress incontinence,” The New England Journal of Medicine, vol. 362, no. 22, pp. 2066–2076, 2010.
[6]  M. E. Albo, H. E. Richter, L. Brubaker et al., “Burch colposuspension versus fascial sling to reduce urinary stress incontinence,” The New England Journal of Medicine, vol. 356, no. 21, pp. 2143–2155, 2007.
[7]  S. A. Shumaker, J. F. Wyman, J. S. Uebersax, D. McClish, and J. A. Fanti, “Health-related quality of life measures for women with urinary incontinence: the incontinence impact questionnaire and the urogenital distress inventory,” Quality of Life Research, vol. 3, no. 5, pp. 291–306, 1994.
[8]  A. R. Herzog and N. H. Fultz, “Prevalence and incidence of urinary incontinence in community-dwelling populations,” Journal of the American Geriatrics Society, vol. 38, no. 3, pp. 273–281, 1990.
[9]  I. Yalcin and R. C. Bump, “Validation of two global impression questionnaires for incontinence,” American Journal of Obstetrics and Gynecology, vol. 189, no. 1, pp. 98–101, 2003.
[10]  M. E. Charlson, P. Pompei, K. A. Ales, and C. R. MacKenzie, “A new method of classifying prognostic comorbidity in longitudinal studies: development and validation,” Journal of Chronic Diseases, vol. 40, no. 5, pp. 373–383, 1987.
[11]  K. Kroenke, R. L. Spitzer, and J. B. W. Williams, “The PHQ-9: validity of a brief depression severity measure,” Journal of General Internal Medicine, vol. 16, no. 9, pp. 606–613, 2001.
[12]  J.-S. Paick, M. C. Cho, S.-J. Oh, S. W. Kim, and J. H. Ku, “Factors influencing the outcome of mid urethral sling procedures for female urinary incontinence,” Journal of Urology, vol. 178, no. 3, pp. 985–989, 2007.
[13]  J. L. Lowder, E. A. Frankman, C. Ghetti et al., “Lower urinary tract symptoms in women with pelvic organ prolapse,” International Urogynecology Journal and Pelvic Floor Dysfunction, vol. 21, no. 6, pp. 665–672, 2010.
[14]  R. C. Bump, P. A. Norton, N. R. Zinner, and I. Yalcin, “Mixed urinary incontinence symptoms: urodynamic findings, incontinence severity, and treatment response,” Obstetrics and Gynecology, vol. 102, no. 1, pp. 76–83, 2003.
[15]  V. A. Minassian, W. F. Stewart, and G. C. Wood, “Urinary incontinence in women: variation in prevalence estimates and risk factors,” Obstetrics and Gynecology, vol. 111, no. 2, pp. 324–331, 2008.
[16]  R. Botlero, S. R. Davis, D. M. Urquhart, S. Shortreed, and R. J. Bell, “Age-specific prevalence of, and factors associated with, different types of urinary incontinence in community-dwelling Australian women assessed with a validated questionnaire,” Maturitas, vol. 62, no. 2, pp. 134–139, 2009.
[17]  T. L. Gamble, H. Du, P. K. Sand, S. M. Botros, M. Rurak, and R. P. Goldberg, “Urge incontinence: estimating environmental and obstetrical risk factors using an identical twin study,” International Urogynecology Journal and Pelvic Floor Dysfunction, vol. 21, no. 8, pp. 939–946, 2010.
[18]  C. S. Bradley, M. B. Zimmerman, Q. Wang, and I. E. Nygaard, “Vaginal descent and pelvic floor symptoms in postmenopausal women: a longitudinal study,” Obstetrics and Gynecology, vol. 111, no. 5, pp. 1148–1153, 2008.
[19]  C. Ghetti, W. T. Gregory, S. R. Edwards, L. N. Otto, and A. L. Clark, “Pelvic organ descent and symptoms of pelvic floor disorders,” American Journal of Obstetrics and Gynecology, vol. 193, no. 1, pp. 53–57, 2005.
[20]  S. Hunskaar, E. P. Arnold, K. Burgio, A. C. Diokno, A. R. Herzog, and V. T. Mallett, “Epidemiology and natural history of urinary incontinence,” International Urogynecology Journal and Pelvic Floor Dysfunction, vol. 11, no. 5, pp. 301–319, 2000.
[21]  L. E. Waetjen, S. Liao, W. O. Johnson et al., “Factors associated with prevalent and incident urinary incontinence in a cohort of midlife women: a longitudinal analysis of data: study of women's health across the nation,” American Journal of Epidemiology, vol. 165, no. 3, pp. 309–318, 2007.
[22]  J. L. Melville, K. Delaney, K. Newton, and W. Katon, “Incontinence severity and major depression in incontinent women,” Obstetrics and Gynecology, vol. 106, no. 3, pp. 585–592, 2005.
[23]  I. Nygaard, C. Turvey, T. L. Burns, E. Crischilles, and R. Wallace, “Urinary incontinence and depression in middle-aged United States women,” Obstetrics and Gynecology, vol. 101, no. 1, pp. 149–156, 2003.
[24]  M. Nuotio, T. Luukkaala, T. L. J. Tammela, and M. Jylh?, “Six-year follow-up and predictors of urgency-associated urinary incontinence and bowel symptoms among the oldest old: a population-based study,” Archives of Gerontology and Geriatrics, vol. 49, no. 2, pp. e85–e90, 2009.
[25]  J. L. Melville, M.-Y. Fan, H. Rau, I. E. Nygaard, and W. J. Katon, “Major depression and urinary incontinence in women: temporal associations in an epidemiologic sample,” American Journal of Obstetrics and Gynecology, vol. 201, no. 5, pp. 490.e1–490.e7, 2009.
[26]  W. D. Steers and K.-S. Lee, “Depression and incontinence,” World Journal of Urology, vol. 19, no. 5, pp. 351–357, 2001.
[27]  A. P. Klausner and W. D. Steers, “Corticotropin releasing factor: a mediator of emotional influences on bladder function,” Journal of Urology, vol. 172, no. 6, pp. 2570–2573, 2004.
[28]  E. P. Peron, Y. Zheng, S. Perera, et al., “Antihypertensive drug class use and differential risk of urinary incontinence in community-dwelling older women,” The Journals of Gerontology A, vol. 67, pp. 1373–1378, 2012.
[29]  H.-C. Tai, S.-D. Chung, C.-H. Ho et al., “Metabolic syndrome components worsen lower urinary tract symptoms in women with type 2 diabetes,” Journal of Clinical Endocrinology and Metabolism, vol. 95, no. 3, pp. 1143–1150, 2010.
[30]  C. Temml, R. Obermayr, M. Marszalek, M. Rauchenwald, S. Madersbacher, and A. Ponholzer, “Are lower urinary tract symptoms influenced by metabolic syndrome?” Urology, vol. 73, no. 3, pp. 544–548, 2009.
[31]  J. M. Wu, A. Kawasaki, A. F. Hundley, A. A. Dieter, E. R. Myers, and V. W. Sung, “Predicting the number of women who will undergo incontinence and prolapse surgery, 2010 to 2050,” American Journal of Obstetrics and Gynecology, vol. 205, no. 3, pp. 230.e1–230.e5, 2011.


comments powered by Disqus

Contact Us


微信:OALib Journal