Сравнительная оценка воздействия различных физических факторов на качество жизни женщин с диагнозом недержание мочи при напряжении

The article reflects the results of a study of the quality of life in patients of perimenopausal age against the background of CO2-laser use on the eve and after complex treatment. Today in Ukraine, the number of women suffering from stress urinary incontinence is steadily growing, and the problem has moved from purely medical to the rank of medical and social. Stress urinary incontinence significantly reduces the quality of life of women, leading to discomfort, causes a woman to change her usual behavior, makes her more withdrawn, is accompanied by serious psychoemotional disorders (depression, psychological stress, depression), leads to severe physical and moral suffering, social maladaptation. That is why assessing the quality of life in women with stress urinary incontinence is considered extremely relevant. Today, conservative and surgical techniques are used to treat stress urinary incontinence. However, none of these methods contributes to the complete disappearance of symptoms of stress urinary incontinence, and the relapse rate after the disease is high, which forces a woman to long-term follow-up and treatment, significantly worsening her quality of life. The objective: to assess the quality of life before and after the use of a CO2-laser in the complex treatment of stress urinary incontinence in premenopausal patients. Materials and methods. 89 patients with stress urinary incontinence were examined. Depending on the prescribed therapy, it is divided into two groups. The main group included 44 women who were offered CO2-laser therapy in combination with local hormone therapy. The comparison group was formed by 45 women who were prescribed only topical estriol therapy. In order to assess the quality of life of women with stress urinary incontinence, a survey of patients was conducted using a specialized PFDI-20 questionnaire, and the FSFI questionnaire was used to assess the female sexuality index. The quality of life score and female sexuality index were determined before treatment and 6 and 12 months after the start of treatment. Results. According to the PFDI-20 questionnaire, 6 months after the start of treatment, there was no significant difference in the number of points in women in the study groups. After 12 months from the start of treatment, significant differences in the median scores were recorded (the main group – 18 points; the comparison group – 30 points; p<0.05). Evaluating the index of sexual function in the dynamics of treatment according to the FSFI questionnaire, a significant increase in this indicator was noted in women of the main group (median before treatment – 25 points; after 6 months from the start of treatment – 35 points; after 12 months from the start of treatment – 46 points; p<0.05). Evaluating the results of the UDI-6 questionnaire 12 months after the start of treatment, we drew attention to significant differences in the symptoms of urinary incontinence in women who received CO2-laser therapy in combination with local estriol therapy before treatment and compared to women who received only estriol locally. Conclusions. The inclusion of a CO2-laser in combination with local administration of estriol in the complex treatment of stress urinary incontinence can significantly reduce the manifestations of this complication, which is confirmed by a significant decrease in the median score from 55 to 18 in women of the main group according to the results of the PFDI-20 questionnaire (p<0.05). The index of sexual function in women who received the proposed complex based on the results of the FSFI questionnaire experienced a significant increase from 25 to 46 points (p<0.05). The results of a survey using the UDI-6 questionnaire indicate a significant reduction in the symptoms of stress urinary incontinence in women in the main group compared to women who received only local estriol therapy. Keywords: stress urinary incontinence, CO2-laser, estriol, quality of life.

To assess the efficacy of physical therapies for first-line use in the treatment and prevention of stress urinary incontinence (SUI) in women, using a systematic review of randomized clinical trials (RCTs). A computer-aided and manual search for published RCTs investigating treatment and prevention of SUI using physical therapies, e.g. pelvic floor muscle (PFM) exercises, with or without other treatment modalities, were carried out. The methodological quality of the included trials was assessed using criteria based on generally accepted principles of interventional research. Twenty-four RCTs (22 treatment and two prevention) were identified; the methodological quality of the studies included was moderate and 11 RCTs were of sufficient quality to be included in further analysis. Based on levels-of-evidence criteria, there is strong evidence to suggest that PFM exercises are effective in reducing the symptoms of SUI. There is limited evidence for the efficacy of high-intensity vs a low-intensity regimen of PFM exercises. Despite significant effects of biofeedback after testing as an adjunct to PFM exercises, there is no evidence that PFM exercises with biofeedback are more effective than PFM exercises alone. There is little consistency (of stimulation types and parameters) in the studies of electrical stimulation, but when the results are combined there is strong evidence to suggest that electrostimulation is superior to sham electrostimulation, and limited evidence that there is no difference between electrostimulation and other physical therapies. In the prevention of SUI the efficacy of PFM exercises, with or without other adjuncts, is uncertain.

The aim of our study was to evaluate the efficiency and safety of synthetic mid-urethral slings (sMUS) for the treatment of stress urinary incontinence (SUI) in women with neurogenic lower urinary tract dysfunction (NLUTD). A systematic review was performed and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. MEDLINE, Embase and Cochrane controlled trials databases were systematically searched from January 1995 to April 2021. Studies including adult women with NLUTD who had a sMUS for SUI were considered for inclusion. Primary outcome was success of the surgery according to study criteria. Secondary outcomes were complications, especially de novo urgency, urinary retention, tape exposure and revision for complications. A total of 752 abstracts were screened and 9 studies were included, representing 298 patients. The mean age was 52years and median follow-up was 41.3months. sMUS insertion was successful in 237 patients (79.5%). The median rate of de novo urgency was 15.7% (range 8.3-30%). In patients with spontaneous voiding, the median rate of retention was 19.3% (range 0-46.7%) and 21 out of 26 patients required intermittent self-catheterisation. Four cases of tape exposure were reported, and 8 patients underwent a revision for complications. This review suggests that sMUS might offer interesting success rates and acceptable morbidity and could be considered for the treatment of SUI in women with NLUTD. Further studies are required to define which patients would be more likely to benefit from this intervention, as well as its place among the other surgical treatments for SUI.

The objective of this study was to perform a cost-utility analysis of nonsurgical treatments for stress urinary incontinence (SUI) in healthy adult women with a health system perspective over a 1-year time horizon. A decision tree model was constructed to evaluate the following nonsurgical treatment options for SUI in a simulated healthy adult female cohort who had failed Kegel exercises: pelvic floor muscle therapy (PFMT), a disposable tampon device (Impressa), a self-fitting intravaginal incontinence device (Uresta), and a traditional incontinence pessary. Published data and consultation with health care providers were used to estimate efficacies and costs. Health utility estimates were derived from existing literature. Deterministic sensitivity analyses were performed as well as Monte Carlo probabilistic sensitivity analysis to account for the impact of parameter uncertainty on costs and efficacies for each treatment. Our primary outcome was the highest net monetary benefit (NMB), which represents the monetary value of the health benefits less the treatment costs. The standard willingness-to-pay threshold of US $50,000 per quality-adjusted life year was used. The utility of SUI in an otherwise healthy patient was 0.81 ± 0.16 and for subjective cure was 0.93 ± 0.08. Using base-case estimates, PFMT was the most cost-effective treatment with an NMB of US $44,098. The Impressa tampon, Uresta, and traditional pessary had NMBs of US $43,970, $43,785, and $42,846, respectively. The probabilistic sensitivity analysis confirmed PFMT to be the most cost-effective treatment option at a willingness to pay of US $50,000 per quality-adjusted life year. The findings of our cost-utility analysis favor PFMT as the most cost-effective nonsurgical treatment option for SUI. Cost-effectiveness for 1 year of treatment was also favorable for Impressa and Uresta. In jurisdictions where there is no public funding for PFMT, Impressa or Uresta are alternatives for women wishing to avoid surgery.

The relationship between lipid accumulation product (LAP) and stress urinary incontinence (SUI) in women remains unclear, and the potential mediating roles of oxidative stress and inflammatory factors in this process have not been extensively studied. This analysis aimed to explore the association between elevated LAP indices and SUI in women, specifically examining the mediating effects of oxidative stress and inflammatory factors. Data from 4,292 participants across 6 consecutive cycles of the National Health and Nutrition Examination Survey were analyzed. Logistic regression and subgroup analyses, adjusted for various covariates, were performed to investigate the relationship between LAP and the prevalence of SUI in adult women. Additionally, mediation analysis was conducted to evaluate the contributions of oxidative stress and inflammatory factors to this association. The prevalence of SUI among women in the United States was 46.02%. After adjustment for confounding factors, the odds ratio for LAP and SUI was 1.003 (95% confidence interval, 1.001-1.004; P=0.002), indicating a positive association. Gamma-glutamyl transferase mediated this relationship, explaining 40.0% of the effect (P=0.036). This study's findings indicate a positive association between LAP and the prevalence of SUI in women, with oxidative stress potentially acting as a mediator in this relationship.

BackgroundPelvic floor muscle training (PFMT) is the first-line treatment for urinary incontinence, but adherence to PFMT is generally poor. Currently, a number of novel strategies exist to facilitate adherence of PFMT. We sought to determine effectiveness of mHealth app-based PFMT for treating stress urinary incontinence (SUI) or stress-predominant mixed urinary incontinence (MUI) in women. The primary objective was to assess the effects of mHealth app-based PFMT and usual treatment on severity of the symptom, the quality of life (QoL) of users and the patient’s global impression of improvement. The secondary objective was to assess how mHealth app use affects adherence of PFMT.MethodsAll randomized controlled trials and quasi-randomized controlled trials aimed at evaluating the effects of mHealth app-based PFMT in women with SUI or stress-predominant MUI were included. Twelve electronic databases, namely the Cochrane Library, PubMed, CINAHL, Embase, Web of science, OVID, SciELO, REHABDATA, PEDro database, Chinese CNKI and Wanfang and the Open Grey databases were used as search sources. The protocol was registered in PROSPERO (CRD 42020183515). This systematic review was developed following the PRISMA 2020 Checklist. The Cochrane Handbook for Systematic Reviews of Interventions for Randomized Controlled Trials was used to assess risk of bias in included studies. Two authors extracted the data into a standardized spreadsheet.ResultsSix studies that met the eligibility criteria were included. The full sample included 439 patients with treatment via mHealth app and 442 controls of usual treatment. ICIQ-UI SF, ICIQ-VS, and QUID scores decreased after follow-up in the mHealth app and control groups in six studies. ICIQ-LUTS QoL scores decreased after follow-up in the mHealth app and control groups in three studies. In only one study, ICIQ-VS QoL scores decreased after 1 month and 2 months of follow-up in the mHealth app group, but increased abruptly after 3 months of follow-up. EQ5D-VAS scores increased in both groups in one study. The percentage of PGI-I increased in the mHealth app group in three studies after follow-up. After follow-up in three studies, BPMSES scores and self-reported adherence scores increased in the mHealth app group relative to the initial time point, but in one study, at 6 months compared with 3 months of follow-up, adherence scores decreased slightly in the mHealth app group.ConclusionsThis systematic review determined that mHealth app-based PFMT showed promise from the perspective of improving both outcomes and exercise adherence.

Background. Paraurethral injection of bulking agents in women is one of the minimally invasive technologies for the treatment of stress urinary incontinence (SUI). The effectiveness and safety of this method depend on the properties of injected substance. Aim. To evaluate the results of paraurethral injections of 1,4-butanediol diglycidyl ether crosslinked high-density hyaluronic acid (EsteFILL® intim) in the treatment of SUI in women of reproductive and perimenopausal age. Materials and methods. We examined 18 patients aged 45.8±5.0 years with mild SUI in combination with grade I–II genital prolapse. After general clinical and special studies (urination diaries, King and PISQ-12 questionnaires, cough test, complex urodynamic study, urethrovesical segment and pelvic floor ultrasound with compression elastography) paraurethral injection of 4.0 ml EsteFILL® intim drug was performed. The results of therapy were studied 1 and 6 months after the procedure. Results. It was found that the injection of the drug contributed to an increase in the stiffness of paraurethral tissues by 1.5 times within 6 months after injection. According to the results of elastography before treatment, the average value of the strain ratio of paraurethral tissues of the proximal posterior wall of the urethra was 0.66±0.46 (0.42–0.91), after 1 and 6 months – 0.99±0.45 (0.76–1.23) and 1.00±0.36 (0.78–1.22) respectively; p=0.009 and 0.018. The effectiveness of EsteFILL® intim drug in the treatment of mild SUI in women after 1 and 6 months according to the results of a cough test was 88.2 and 71.4%, according to urination diaries – 88.9 and 66.7% respectively. During the entire observation period the patients noted a decrease in the degree of discomfort due to SUI and an improvement in the quality of life. Conclusion. Paraurethral injection of EsteFILL® intim drug helps to increase the stiffness of the urethra supporting structures in patients with SUI. This method of treating SUI is effective for women of reproductive and perimenopausal age with mild severity disease, who do not plan surgical treatment, are interested in achieving a quick result of therapy and are informed that the effect decreases over time after the procedure.

€‚ Neuromuscular electrical stimulation (NMES) is commonly used to treat lower urinary tract dysfunctions. This study evaluated the efficacy of a novel externally applied stimulator in the treatment of stress urinary incontinence (SUI). €‚ Nine women were included in this study. Provocative tests included a cough and jumping jack test assessed via pad weight. Ultrasound (US) imaging assessed pelvic floor muscle (PFM) contraction. A bladder filling protocol allowed for delineation of the bladder from the pelvic floor and standardized volume. External electrodes were used during 30 €ƒmin, at least four times per week treatment protocol at home for eight weeks. Participants were blinded to US and were not instructed regarding pelvic floor contractions. €‚ At week 1, participants could perform PFM contractions verified with US. More importantly, an 87.43% decrease in leakage was noted. At week 8, participants reported a 97.71% decrease in leakage (p= 0.0001). Changes noted in Incontinence Impact Questionnaire and Modified Oxford scores were significant (p= 0.0001 and p= 0.0001). €‚ NMES is frequently used to promote muscle strength and coordination. Studies have shown NMES to be effective in decreasing symptoms associated with SUI; however, few, if any, have used it as a primary treatment modality. The novel device in this study was shown to be effective in improving muscle strength, reducing or ablating the symptoms associated with SUI, and in eliciting PFM contractions. The device is noninvasive and can be used as a home treatment.

The educational sessions of the 2012 Canadian Urology Forum were informative not only because of the evidence-based and practical guidance they provided, but also due to the gaps in knowledge identified during these comprehensive overviews. The following brief review provides a recap of the most important of these outstanding questions, whose answers would provide invaluable information in helping health-care professionals manage stress urinary incontinence (SUI) in women and lower urinary tract symptoms (LUTS) in men.

Background:To conduct a meta-analysis of the effectiveness and safety of acupuncture combined with pelvic floor muscle training (PFMT) vs PFMT for the treatment of female stress urinary incontinence (SUI).Methods:Four English databases (PubMed, EMBASE, Web of Science, and Cochrane Library) and 4 Chinese databases (the China National Knowledge Infrastructure, Wanfang DATA, the Chongqing VIP Database, China Biomedical Database) were manually searched for literature published from dates of the inception of the databases to December 23rd, 2023. Randomized controlled trials (RCTs) of acupuncture combined with PFMT vs PFMT for female SUI were included. Relevant literature was screened, and the data of the included studies were extracted according to the risk of bias tool for quality assessment.Results:A total of 1974 patients were included in 22 RCTs. There were 990 cases in the experimental group (acupuncture combined with PFMT) and 984 cases in the control group (PFMT). The result showed that combination treatment was superior to PFMT alone, and there were statistically significant differences in several outcomes including relative risk in change for total effective rate (relative risk = 1.29, 95% CI 1.21–1.37, P < .001), weighted mean differences (WMD) in change for urine leakage on a 1-hour pad test (WMD = −2.58, 95% CI −3.33 to −1.84, P < .001), Incontinence Questionnaire-Short Form score (WMD = −2.69, 95% CI −3.45 to −1.92, P < .001), Quality of Life Questionnaire score (WMD = 11.09, 95% CI 8.41–13.77, P < .001), and IIQ-7 score (WMD = −3.35, 95% CI −4.14 to −2.56, P < .001).Conclusion:Acupuncture combined with PFMT can significantly reduce the urine leakage on a 1-hour pad test, and improve the total effective rate and quality of life in female SUI patients. However, the number of included articles are limited, and more high-quality RCTs are needed to validate these results.

Weight Loss Prevents Urinary Incontinence in Women With Type 2 Diabetes: Results From the Look AHEAD Trial

We compared two hypotheses as to why obesity is associated with stress urinary incontinence (SUI): (1) obesity increases demand on the continence system (e.g. higher cough pressure) and (2) obesity compromises urethral function and urethrovaginal support. A secondary analysis was performed using data from a case-control study of SUI in women. Measurements of urethrovaginal support (POP-Q point Aa, urethral axis), urethral function (maximal urethral closure pressure, MUCP), and measures of continence system demand (intravesical pressures at rest and during maximal cough) were analyzed. Cases and controls were divided into three body mass index (BMI) groups: normal (18.5-24.9kg/m2); overweight (25.0-29.9kg/m2); and obese (≥30kg/m2). Logistic regression models where created to investigate variables related to SUI for each BMI group. Structural equation modeling was used to test the direct and indirect relationships among BMI, SUI, maximal cough pressure, MUCP, and POP-Q point Aa. The study included 108 continent controls and 103 women with SUI. MUCP was the factor most strongly associated with SUI in all BMI groups. Maximal cough pressure was significantly associated with SUI in obese women (OR 3.191, 95% CI 1.326, 7.683; p < 0.01), but not in normal weight or overweight women. Path model analysis showed a significant relationship between BMI and SUI through maximal cough pressure (indirect effect, p = 0.038), but not through MUCP (indirect effect, p = 0.243) or POP-Q point Aa (indirect effect, p = 0.410). Our results support the first hypothesis that obesity is associated with SUI because of increased intravesical pressure, which therefore increases demand on the continence mechanism.

Anterior vaginal repair (anterior colporrhaphy) is an operation traditionally used for moderate or severe stress urinary incontinence (SUI) in women. About a third of adult women experience urinary incontinence. SUI imposes significant health and economic burden to the society and the women affected. To determine the effects of anterior vaginal repair (anterior colporrhaphy) on urinary incontinence in comparison with other management options. We searched the Cochrane Incontinence Group Specialised Trials Register (searched 1 September 2009) and the reference lists of relevant articles. Randomised or quasi-randomised trials that included anterior vaginal repair for the treatment of urinary incontinence. Two review authors independently extracted data and assessed trial quality. Three trial investigators were contacted for additional information. Ten trials were identified which included 385 women having an anterior vaginal repair and 627 who received comparison interventions.A single small trial provided insufficient evidence to assess anterior vaginal repair in comparison with physical therapy. The performance of anterior repair in comparison with bladder neck needle suspension appeared similar (risk ratio (RR) for failure after one year 1.16, 95% confidence interval (CI) 0.86 to 1.56), but clinically important differences could not be confidently ruled out. No trials compared anterior repair with suburethral sling operations or laparoscopic colposuspensions, or compared alternative vaginal operations.Anterior vaginal repair was less effective than open abdominal retropubic suspension based on patient-reported cure rates in eight trials both in the medium term (failure rate within one to five years after anterior repair 97/259 (38%) versus 57/327 (17%); RR 2.29, 95% confidence Interval (CI) 1.70 to 3.08) and in the long term (after five years, (49/128 (38%) versus 31/145 (21%); RR 2.02, 95% CI 1.36 to 3.01). There was evidence from three of these trials that this was reflected in a need for more repeat operations for incontinence (25/107 (23%) versus 4/164 (2%); RR 8.87, 95% CI 3.28 to 23.94). These findings held, irrespective of the co-existence of prolapse (pelvic relaxation). Although fewer women had a prolapse after anterior repair (RR 0.24, 95% CI 0.12 to 0.47), later prolapse operation appeared to be equally common after vaginal (3%) or abdominal (4%) operation.In respect of the type of open abdominal retropubic suspension, most data related to comparisons of anterior vaginal repair with Burch colposuspension. The few data describing comparison of anterior repair with the Marshall-Marchetti-Krantz procedure were consistent with those for Burch colposuspension. There were not enough data to allow comparison of anterior vaginal repair with physical therapy or needle suspension for primary urinary stress incontinence in women. Open abdominal retropubic suspension appeared to be better than anterior vaginal repair judged on subjective cure rates in eight trials, even in women who had prolapse in addition to stress incontinence (six trials). The need for repeat incontinence surgery was also less after the abdominal operation. However, there was not enough information about postoperative complications and morbidity.A Brief Economic Commentary (BEC) identified one study suggesting that vaginoplasty may be more cost-effective compared with tension-free vaginal tape (TVT-O).

Strengthening exercises for pelvic floor muscles (SEPFM) are considered the first approach in the treatment of stress urinary incontinence (SUI). Nevertheless, there is no evidence about training parameters. To identify the protocol and/or most effective training parameters in the treatment of female SUI. A literature research was conducted in the PubMed, Cochrane Library, PEDro, Web of Science and Lilacs databases, with publishing dates ranging from January 1992 to March 2014. The articles included consisted of English-speaking experimental studies in which SEPFM were compared with placebo treatment (usual or untreated). The sample had a diagnosis of SUI and their age ranged between 18 and 65 years. The assessment of methodological quality was performed based on the PEDro scale. Seven high methodological quality articles were included in this review. The sample consisted of 331 women, mean age 44.4±5.51 years, average duration of urinary loss of 64±5.66 months and severity of SUI ranging from mild to severe. SEPFM programs included different training parameters concerning the PFM. Some studies have applied abdominal training and adjuvant techniques. Urine leakage cure rates varied from 28.6 to 80%, while the strength increase of PFM varied from 15.6 to 161.7%. The most effective training protocol consists of SEPFM by digital palpation combined with biofeedback monitoring and vaginal cones, including 12 week training parameters, and ten repetitions per series in different positions compared with SEPFM alone or a lack of treatment.

In Brief Objectives: To assess tension-free vaginal tape for the treatment of occult stress urinary incontinence in women undergoing reconstructive surgery for prolapse. Methods: We conducted a retrospective case series of 32 women with pelvic organ prolapse and occult stress urinary incontinence undergoing surgery with concomitant tension-free vaginal tape (TVT) in a tertiary care hospital during 1998 to 2003. Incontinence was occult if asymptomatic and only demonstrable with the prolapse reduced. Preoperative prolapse was at or beyond the level of the hymen. Cure of incontinence was assessed after 1 year by the absence of objective urine leakage during clinical examination with coughing and during urodynamics. Results: Thirty-two patients underwent TVT with concomitant prolapse repair. One year after surgery, clinical examination with coughing showed recurrence of stress incontinence in 2 of 32 patients (6.3%), and leak at urodynamics showed a failure of 3 of 32 (9.4%). Subjective incontinence failure was present in 2 of 32 patients (6.3%). Six patients (19%) had recurrence of cystocele at or beyond the hymen at 1 year. Three patients (9%) had a cystotomy at the time of TVT placement; however, these were all recognized at the time of surgery, and there were no sequelae. One patient required intermittent self-catheterization on a long-term basis. Conclusions: TVT offers good cure in patients with occult stress incontinence undergoing prolapse repair. In order to assess tension-free vaginal tape for the treatment of occult stress urinary incontinence in women undergoing reconstructive surgery for prolapse, the authors conducted a retrospective case series of 32 women. At 1 year after surgery, patients showed a good cure rate by clinical examination and urodynamics.