Incontinence
URINARY DISTRESS SYMPTOM-6 SCORE
https://www.thecalculator.co/health/Urogenital-Distress-Inventory-Short-Form-(UDI-6)-Calculator-1127.html
MEDICATION
A meta-analysis in 2018 found that compared to mirabegron, there was some evidence that onabotulinumtoxinA was associated with improved outcomes, including reductions in the number of micturitions in a 24-hour period, and the number of incontinence episodes. However, mirabegron was associated with a lower risk of urinary tract infections compared with onabotulinumtoxinA. (11)
MIDURETRHAL SLING (MUS)
Click here for more information for MUS
ARTIFICIAL URETHRAL SPHINCTER (AUS)
Click here for more information about AUS. First introduced in 1972, revision rates at 1, 2, 3 years 90-94%, 88%, 81% respectively, with DM and ASA score significant risk factors shown in one prospective study. Radiation, penoscrotal approach are also risk factors for revision. As time progresses since AUS placement, here is generally a decline in continence status and QOL that begins within 1 year after placement. (3). At 5 years the revision rate is 59% to 79%. (4,5,6,7,8)
ELECTROACUPUNCTURE
In 504 women in a study in China, electroacupuncture vs. sham- after 6 weeks, mean leak lower (9.9gm vs. 2.6gm), slightly less number of leak episdodes (1)
CANNABINOIDS
In a study that screened 8 469 articles, there were included two randomized controlled trials and one open-label study, in which a total of 426 patients were enrolled. Cannabinoids relevantly decreased the number of incontinence episodes in all three studies. Pooling data showed the mean difference in incontinence episodes per 24 h to be -0.35 (95% confidence interval -0.46 to -0.24). Mild adverse events were frequent (38-100%), but only two patients (0.7%) reported a serious adverse event. Preliminary data imply that cannabinoids might be an effective and safe treatment option for NLUTD in patients with MS; however, the evidence base is poor and more high-quality, well-designed and adequately powered and sampled studies are urgently needed to reach definitive conclusions. (2)
VITAMIN D
A 2016 study showed baseline Vitamin D insufficiency statistically associated with increased risk of UI. There is a concentrated Vit D receptor population in bladder and supportive pelvic muscles. (9)
BARIATRIC SURGERY
Small Israeli study of 29 incontinent women undergoing bariatric surgery showed incontinence frequency reduced from 1.96 to 0.74 with 15 of 29 having complete resolution. (10)
RELATION TO TESTOSTERONE
A study of 2321 women found low testosterone associated with increased likelihood of stress and mixed UI in women. (11)
https://www.thecalculator.co/health/Urogenital-Distress-Inventory-Short-Form-(UDI-6)-Calculator-1127.html
MEDICATION
A meta-analysis in 2018 found that compared to mirabegron, there was some evidence that onabotulinumtoxinA was associated with improved outcomes, including reductions in the number of micturitions in a 24-hour period, and the number of incontinence episodes. However, mirabegron was associated with a lower risk of urinary tract infections compared with onabotulinumtoxinA. (11)
MIDURETRHAL SLING (MUS)
Click here for more information for MUS
ARTIFICIAL URETHRAL SPHINCTER (AUS)
Click here for more information about AUS. First introduced in 1972, revision rates at 1, 2, 3 years 90-94%, 88%, 81% respectively, with DM and ASA score significant risk factors shown in one prospective study. Radiation, penoscrotal approach are also risk factors for revision. As time progresses since AUS placement, here is generally a decline in continence status and QOL that begins within 1 year after placement. (3). At 5 years the revision rate is 59% to 79%. (4,5,6,7,8)
ELECTROACUPUNCTURE
In 504 women in a study in China, electroacupuncture vs. sham- after 6 weeks, mean leak lower (9.9gm vs. 2.6gm), slightly less number of leak episdodes (1)
CANNABINOIDS
In a study that screened 8 469 articles, there were included two randomized controlled trials and one open-label study, in which a total of 426 patients were enrolled. Cannabinoids relevantly decreased the number of incontinence episodes in all three studies. Pooling data showed the mean difference in incontinence episodes per 24 h to be -0.35 (95% confidence interval -0.46 to -0.24). Mild adverse events were frequent (38-100%), but only two patients (0.7%) reported a serious adverse event. Preliminary data imply that cannabinoids might be an effective and safe treatment option for NLUTD in patients with MS; however, the evidence base is poor and more high-quality, well-designed and adequately powered and sampled studies are urgently needed to reach definitive conclusions. (2)
VITAMIN D
A 2016 study showed baseline Vitamin D insufficiency statistically associated with increased risk of UI. There is a concentrated Vit D receptor population in bladder and supportive pelvic muscles. (9)
BARIATRIC SURGERY
Small Israeli study of 29 incontinent women undergoing bariatric surgery showed incontinence frequency reduced from 1.96 to 0.74 with 15 of 29 having complete resolution. (10)
RELATION TO TESTOSTERONE
A study of 2321 women found low testosterone associated with increased likelihood of stress and mixed UI in women. (11)
- Liu, Zhishun, et al. "Effect of electroacupuncture on urinary leakage among women with stress urinary incontinence: a randomized clinical trial." Jama 317.24 (2017): 2493-2501.
- Abo Youssef, Nadim, et al. "Cannabinoids for treating neurogenic lower urinary tract dysfunction in patients with multiple sclerosis: a systematic review and meta‐analysis." BJU international 119.4 (2017): 515-521.
- Kaiho, Yasuhiro, et al. "Surgical and patient reported outcomes of artificial urinary sphincter implantation: a multicenter, prospective, observational study." The Journal of urology 199.1 (2018): 245-250.
- Viers, Boyd R., et al. "Long-term quality of life and functional outcomes among primary and secondary artificial urinary sphincter implantations in men with stress urinary incontinence." The Journal of urology 196.3 (2016): 838-843.
- Suh, Yoon Seok, et al. "Long‐term outcomes of primary implantation and revisions of artificial urinary sphincter in men with stress urinary incontinence." Neurourology and urodynamics 36.7 (2017): 1930-1937.
- Léon, Priscilla, et al. "Long‐term functional outcomes after artificial urinary sphincter implantation in men with stress urinary incontinence." BJU international 115.6 (2015): 951-957.
- Lai, H. Henry, et al. "13 years of experience with artificial urinary sphincter implantation at Baylor College of Medicine." The Journal of urology 177.3 (2007): 1021-1025.
- Raj, Ganesh V., et al. "Outcomes following revisions and secondary implantation of the artificial urinary sphincter." The Journal of urology 173.4 (2005): 1242-1245.
- Vaughan, Camille P., et al. "Vitamin D and incident urinary incontinence in older adults." European journal of clinical nutrition 70.9 (2016): 987.
- Shimonov, Mordechai, et al. "Is bariatric surgery the answer to urinary incontinence in obese women?." Neurourology and urodynamics 36.1 (2017): 184-187.
- Kim, M. M., & Kreydin, E. I. (2018). The Association of Serum Testosterone Levels and Urinary Incontinence in Women. The Journal of Urology, 199(2), 522–527.