Small Extracellular Vesicles Secreted by Peri-urethral Tissues Regulate Fibroblast Function and Contribute to the Pathogenesis of Female Stress Urinary Incontinence

Objective:This study aimed to explore the existence of small extracellular vesicles(sEVs)in peri-urethral tissues and the role of abnormal expression of sEVs in the pathogenesis of female stress urinary incontinence(SUI).Methods:sEVs were extracted from peri-urethral vaginal wall tissues using differential centrifugation and were observed by transmission electron microscopy(TEM).The number of sEVs and their protein contents were compared between SUI and control groups using nanoparticle tracking analysis(NTA)and bicinchoninic acid(BCA)protein assay.Fibroblasts were cultured separately with SUI(SsEVs group)and normal tissue sEVs(NsEVs group).Proliferation and migration of fibroblasts were compared between groups using CCK-8 and wound healing assays,respectively.Expression levels of collagenⅠandⅢwere compared among blank control(BC),NsEVs,and SsEVs groups using real-time PCR.Protein mass spectrometry was used to test the differentially expressed proteins contained in sEVs between groups.Results:sEVs were extracted and found under the electron microscope.There were significantly more sEVs extracted from the SUI group compared to the normal group.Fibroblasts showed increased proliferative and decreased migratory abilities,and expressed more collagen in the SsEVs group compared to the NsEVs and BC groups.Protein spectrum analysis demonstrated several differentially expressed targets,including components of microfibrils,elastin polymer,and anti-inflammatory factors.Conclusion:sEVs were detected in the peri-urethral tissues.SUI tissues expressed more sEVs than control.The abnormal expression of sEVs and their protein contents may contribute to the pathogenesis and progression of SUI.

The prevalence,associated factors,and impact of urinary incontinence in pregnant and postpartum women in Nanjing,China:A cross-sectional study

Objective:Urinary incontinence(UI)is highly prevalent in antenatal and postnatal women while the prevalence of UI varied largely from 3.84%to 38.65%.This study was to assess the prevalence of UI,the associated factors,and the impact of UI on daily life in pregnant and postpartum women in Nanjing,China.Methods:The prevalence of UI and the impact of UI on life were assessed by the validated Chinese version of International Consultation on Incontinence Questionnaire-urinary incontinence-short form and the validated Chinese version of urinary incontinence quality of life.The associated factors were estimated by using logistic regression analysis.Results:UI affected 37.80%of pregnant women and 16.41%of postpartum women of the study population.Among the pregnant participants,the prevalence rates of stress UI,urge UI,and mixed UI were 25.77%,4.47%,and 7.10%,respectively.Among the postpartum women,the prevalence rates of stress UI,urge UI,and mixed UI were 11.15%,1.92%,and 2.69%,respectively.In both pregnant women and postpartum women,vaginal delivery had significantly increased the odds of reporting UI(p=0.007,p=0.003,respectively).The impact of UI on daily life was significantly greater in postpartum women compared to pregnant women especially in social embarrassment(p=0.000).Conclusion:The prevalence rates of UI were high in pregnant women in Nanjing,China.Vaginal delivery significantly increased odds of reporting UI.UI has a great impact on pregnant and postpartum women’s life,especially in social embarrassment.

Non-Ablative Transvaginal Radiofrequency in the Treatment of Stress Urinary Incontinence: Review of the Literature

Background: Urinary incontinence is defined as the involuntary loss of urine, which can affect up to 45% of women after menopause. Radiofrequency is a non-invasive procedure that involves the application of an electromagnetic wave that through heat generation promotes neocollagenesis and neoeslatinogenesis in the vaginal epithelium. This energy-based technology has been studied as a potential alternative for the treatment of genitourinary syndrome of menopause and urinary incontinence. Objective: To review the recent literature (from 2020 to June 2022) on the use of transvaginal radiofrequency in the treatment of stress urinary incontinence, by searching articles at databases of Capes, PubMed Cochrane and Scielo. Methods: The descriptor terms “Urinary Incontinence/therapy” [Majr] AND “Urinary Incontinence, Stress/therapy” [Majr] AND RADIOFREQUENCY-Search Results-PubMed, [“woman” OR “women”] AND [“urinary incontinence” OR “stress urinary incontinence”] AND Radiofrequency were used, with a filter for the period 2020 to 2022. Conclusion: The studies evaluated in this review demonstrated significant results of radiofrequency in the resolution or reduction of complaints of women with urinary incontinence, especially stress urinary incontinence, but most of these studies presented a low methodological quality. There is, therefore, a lack of studies with longer follow-ups, evaluation of cost-effectiveness, randomized clinical trials with objective outcomes and the use of validated questionnaires with international acceptance.

Is There Any Relationship between Total Hip Arthroplasty and Urinary Incontinent?

Introduction: In my daily practice as a hip surgeon, I have observed some circumstances where urinary incontinence (UI) improves after total hip arthroplasty (THA). We investigated UI symptoms before and after THA at our facility and considered the factors that influence UI. Patients and Method: The subjects were 113 female patients who underwent primary THA in our facility. An anterior lateral approach was used in all cases. Using the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), we conducted an investigation into the presence of UI before and 2 weeks after THA. An improvement in UI was defined as a decrease of 1 point or more, a worsening is defined as an increase of 1 point or more. Results: The responses from the 113 subjects were analyzed. Of the 113 patients, prior to THA, UI was prevalent among 59 patients and was absent among 54 patients. In the group where UI was prevalent, it improved after THA in 50 patients (85%), remained unchanged in 5 (8%) and worsened in 4 (7%). In the group where UI was absent, 49 patients (91%) remained unchanged and UI appeared in 5 (9%). Compared with the non-prevalence group (62 patients), the prevalence group (50 patients) had a noticeable improvement rate of internal rotation of the surgical hip side (P Conclusion: UI greatly reduces the quality of life (QOL). In this study, there is a possibility that THA improves UI.

Magnetic resonance imaging in assessment of stress urinary incontinence in women: Parameters differentiating urethral hypermobility and intrinsic sphincter deficiency

AIM: To define the magnetic resonance imaging(MRI) parameters differentiating urethral hypermobility(UH) and intrinsic sphincter deficiency(ISD) in women with stress urinary incontinence(SUI).METHODS: The static and dynamic MR images of 21 patients with SUI were correlated to urodynamic(UD) findings and compared to those of 10 continent controls. For the assessment of the urethra and integrity of the urethral support structures, we applied the highresolution endocavitary MRI, such as intraurethral MRI, endovaginal or endorectal MRI. For the functional imaging of the urethral support, we performed dynamic MRI with the pelvic phased array coil. We assessed the following MRI parameters in both the patient and thevolunteer groups:(1) urethral angle;(2) bladder neck descent;(3) status of the periurethral ligaments,(4) vaginal shape;(5) urethral sphincter integrity, length and muscle thickness at mid urethra;(6) bladder neck funneling;(7) status of the puborectalis muscle;(8) pubo-vaginal distance. UDs parameters were assessed in the patient study group as follows:(1) urethral mobility angle on Q-tip test;(2) Valsalva leak point pressure(VLPP) measured at 250 cc bladder volume; and(3) maximum urethral closure pressure(MUCP). The UH type of SUI was defined with the Q-tip test angle over 30 degrees, and VLPP pressure over 60 cm H2 O. The ISD incontinence was defined with MUCP pressure below 20 cm H2 O, and VLPP pressure less or equal to 60 cm H2 O. We considered the associations between the MRI and clinical data and UDs using a variety of statistical tools to include linear regression, multivariate logistic regression and receiver operating characteristic(ROC) analysis. All statistical analyses were performed using STATA version 9.0(Stata Corp LP, College Station, TX).RESULTS: In the incontinent group, 52% have history of vaginal delivery trauma as compared to none in control group(P < 0.001). There was no difference between the continent volunteers and incontinent patients in body habitus as assessed by the body mass index. Pubovaginal distance and periurethral ligament disruption are significantly associated with incontinence; periurethral ligament symmetricity reduces the odds of incontinence by 87%. Bladder neck funneling and length of the suprapubic urethral sphincter are significantly associated with the type of incontinence on UDs; funneling reduced the odds of pure UH by almost 95%; increasing suprapubic urethral sphincter length at rest is highly associated with UH. Both MRI variables result in a predictive model for UDs diagnosis(area under the ROC = 0.944). CONCLUSION: MRI may play an important role in assessing the contribution of hypermobility and sphincteric dysfunction to the SUI in women when considering treatment options.

Effect of Comprehensive Nursing Intervention in Patients with Urinary Incontinence After Radical Prostatectomy

Objective:To explore and analyze the clinical effect of comprehensive nursing intervention in patients with urinary incontinence after radical prostatectomy.Methods:84 patients with urinary incontinence after radical prostatectomy admitted to the Urology Department between May 2021 and May 2023 were included in this study.The patients were divided into a comprehensive group and a control group,with 42 cases in each group through a double-blind mechanism.The comprehensive group received comprehensive nursing care,and the control group received primary nursing care.The duration of indwelling urinary catheters and urinary incontinence;psychological performance and living conditions were compared between the two groups.Results:The duration of the indwelling urinary catheter and urinary incontinence of the patients in the comprehensive group were significantly shorter than that in the control group(P<0.05).Before nursing,there was no statistically significant difference in the anxiety,depression,and other psychological manifestations between the two groups(P>0.05);after nursing,the comprehensive group’s anxiety,depression,and other psychological manifestations of the comprehensive group were significantly lower than those of the control group(P<0.05).Before nursing,there was no statistically significant difference in the physical function,mental state,emotional state,and physical recovery of the patients between both groups(P>0.05);after nursing,the physical function,mental state,emotional state,physical recovery of the patients in the comprehensive group were significantly better than those of the control group.Besides,the living conditions of the patients in the comprehensive group were also significantly better than the control group’s(P<0.05).Conclusion:Comprehensive nursing intervention can effectively improve symptoms of urinary incontinence after radical prostatectomy,reduce inner pressure,and improve living standards.

Catgut Implantation at Baliao and Xingfu One Acupuncture Point to Treat Urinary Incontinence in Patients with Incomplete Spinal Cord Injury: Three Cases Report

Objective: To explore the effect of catgut implantation at Baliao and Xingfu One Acupuncture point for patients with urinary incontinence secondary to spinal cord injury (SCI). Methods: Three SCI patients received catgut embedding at Baliao and Xingfu One Acupuncture point. The data of intermittent catheterization (IC) volume, intermittent catheterization frequency and the amount of using urine pad (urethral condom) were corrected. Results: Compared to the baseline data, IC volume increased and the leakage volume decreased. Conclusions: Catgut Implantation at Baliao and Xingfu One Acupuncture point is effective for patients with urinary incontinence secondary to incomplete SCI.

Pressure assessment in intercavernous embedding of bulboperineal urethra for treatment of urinary incontinence after prostatic operation

Aim: To put forward criteria for the pressure assessment in the operation of intercavernous embedding of bulboper-ineal urethra for the treatment of urinary incontinence after prostatic operation. Methods: A F14 urethral catheter isinserted during the operation and upon suturing the corpora cavernosa centrally, the catheter is slowly pushed in andpulled out in order that the operator feels a certain degree of close-fit resistance. The degree of tightness of the stitches,which regulate the compression pressure, is adjusted in accordance with this close-fit sensation. To further ascertain theadequacy of the force of compression, the bladder is filled with 300 ml physiological saline and observe the appropriate-ness (size and continuity) of the outflow stream when the lower abdomen is depressed with a pressure of 80 - 90 cmH_2O. The operation was given to six patients suffered from urinary incontinence for 20 or more months after prostaticoperation. Results: Five cases achieved complete recovery, while the therapeutic effect of the 6th one was not sat-isfactory . A second stage operation was carried out 3 months later with the addition of one more stitch both proximallyand distally to reinforce the compression force. The condition was improved dramatically. The follow-up period aver-aged 3.5 years. Conclusion; The adequacy of the compression pressure exerted by the juxtaposed corpora cavernosais the key point determining the outcome of the operation. The measures for assessing the compression pressure suggest-ed by the authors are helpful in obtaining the good results of the present paper (6/6 success) as compared with 25/34success in the previous report. (Asian J Androl 2001 Sep; 3: 235 — 237)

The Suburethral Sling Transobturator Approach for Stress Urinary Incontinence Treatment in Women in the Maternity and Neonatology Center of Tunis (WTSC)

The authors, through a descriptive retrospective study have evaluated the results of surgical treatment, by Tension-Free Obturator tape (TOT) technique, of urinary incontinence in the first 68 patients operated in the Department “C” of Obstetrics and Gynecology of the Maternity and Neonatology Centre of Tunis (WTSC). The average age in those patients was 55.14 ± 8.47 years with extremes of 40 and 82 years. The majority of the patients (72%) were under the age of 60 years. In sixty-one patients (89%), no urine leak has been detected and they were healed. In three patients (4%) there was improvement with partial recovery. Three other (4%) did not notice any improvement after the surgery. No case of dysuria or rejection of the strip has been reported. It was concluded that the declared satisfaction rate is 93%.

Types of Urinary Incontinence Prevalent among Kuwaiti Women with Type Two Diabetes Mellitus

The aim of this study was to determine the types of urinary incontinence prevalent among Kuwaiti women with Type two Diabetes Mellitus attending the outpatient clinic at the Urology center and suggest appropriate nursing interventions. Urinary incontinence is not a life threatening condition but it can be emotionally devastating and therefore affects the sufferer’s quality of life. This cross-sectional descriptive survey consisted of 250 Kuwaiti women with type two diabetes mellitus receiving treatment at the outpatient department at Sabah Al-Ahmad Urology Center, Kuwait. The questionnaire comprised of a total of 33 questions, twelve of which explored participants’ socio demographic characteristics, risk factors and symptoms of their urinary incontinence. The remaining 21 items were adapted from King’s Health Questionnaire (KHQ) formulated in 1997 at King’s college, London, for the assessment of quality of life in women with urinary incontinence. Data collection was from February to May 2014. The result revealed that mixed urinary incontinence was the most prevalent type of urinary incontinence affecting Kuwaiti women with type two diabetes mellitus. Symptoms of both stress incontinence and urge incontinence (Over active bladder) were not mutually exclusive as they were present in 247 (98.8%) and 240 (96%) of the participants respectively. Key risk factors for developing incontinence were over three years duration of diabetes mellitus in 115 (56%) and delivery of one or more children reported by 206 (82%) of the participants. Analysis and result of King Health Questionnaire on quality of life will be reported in separate paper on the psychosocial impact of urinary incontinence on diabetic Kuwaiti women. In conclusion, urinary incontinence had a devastating effect on the lives of sufferers and therefore should be prevented at all cost by nurses providing anticipatory guidance to all pregnant and diabetic women and routinely teaching pelvic floor exercises to all postnatal women. However, in the event that there are symptoms of urinary incontinence then thorough investigation and early treatment is advocated.

The Psycho-Social Impact of Urinary Incontinence on the Quality of Life among Kuwaiti Women with Type 2 Diabetes Mellitus

This study was conducted to determine the psycho-social impact of urinary incontinence (UI) on the quality of life of 250 Kuwaiti women with type 2 diabetic mellitus (DM). A survey method, using a 33-item 5-point Likert scale Arabic questionnaire adapted from the King’s Health Questionnaire (KHQ), was employed for data collection from February to May, 2014 while all the participants were receiving treatment for UI at a specialized urology center in Kuwait. Participants with UI and a co-morbidity of type 2 DM and obesity were 20 to 65 years old. Results showed the following variables were statistically significant for frequency of urine leak: Age was (χ2 = 36.877, df = 3, P ≤ 0.000). Parity showed nulliparous women reported less urine leak compared to parous women: Chi-square was (χ2 = 24.83, df = 12, P ≤ 0.016). Type 2 DM for more than 3 years duration had the highest incidence of several leaks per day. BMI of above 25 kg/m2 caused daily urine leak: Chi-square (χ2 = 17.912, df = 9, P ≤ 0.036). Participants’ self reports of good general health were those who leaked urine either 2 - 3 times weekly or occasionally. Finally, the impact of incontinence on their lifestyle was reported as extreme by 128 (51.2%), and 6 (2.4%) reported little or no impact on their quality of life: Chi-square was (χ2 = 52.392, df = 18, P ≤ 0.000). In conclusion, this study showed a clear correlation between UI and reduced quality of life. Midwives are well positioned to correct the myth that UI is an inevitable byproduct of childbearing. Midwives should explain to all pregnant women how childbirth can be a risk factor and provide anticipatory guidance by teaching preventive measures like pelvic floor exercises before and after delivery. Family members should assist sufferers in coping with their challenges by dispelling any form of stigmatization, joining them in practicing pelvic floor exercises, and encouraging, empathizing and supporting them emotionally.

Effects of Pregnancy and Delivery in Women with Previous Surgery for Stress Urinary Incontinence with Suburethral Band: A Bibliographic Review

The continence status and the most adequate form of delivery were assessed in pregnant women who had a suburethral band to treat stress urinary incontinence (SUI). A group of 57 women selected from different articles published between 2000 and 2014 were reviewed. These women had become pregnant after having undergone a suburethral band procedure. Different aspects such as age, parity, type of band, time elapsed between the procedure and the pregnancy, SUI during pregnancy and after delivery, and the form of delivery were evaluated, as well as the possible relationship with the recurrence of SUI and the emergence of complications associated with the suburethral during pregnancy. A case of a complication related to a suburethral band was found in one patient who developed an episode of pyelonephritis and intermittent urethral obstruction which required a Foley catheter. Thirty patients had cesarean section while 27 had vaginal deliveries;12 patients had incontinence during pregnancy and 15 suffered from it after delivery. Postpartum SUI in relation with the delivery form did not show statistically relevant differences between the cesarean section group and the vaginal delivery group. It was observed that the emergence of SUI during pregnancy was a risk factor for the onset of postpartum SUI (OR = 6.47;p = 0.0137). The risk of developing postpartum SUI seems similar regardless the delivery form, thus it is plausible to recommend vaginal delivery to these patients. If there was a recurrence of SUI, a second suburethral band could be placed which would be as effective as the first one and would involve a lower risk surgery compared to a cesarean section.

Risk Factors for Urinary Incontinence after Obstetric Vesicovaginal Fistula Closure in Guinea

Introduction: Urinary incontinence after closure of vesicovaginal fistula is any involuntary loss of urine that a patient complains of. We aim to study the risk factors for urinary incontinence after closure of obstetric vesicovaginal fistula in Guinea in order to develop preventive measures to reduce its incidence. Materials and Methods: This was a retrospective, multiple center cohort of women operated on for obstetric vesicovaginal fistula during a 10-year period. Results: In 1770 vesicovaginal fistulas operated, 1347 were closed. 180 women (13.36%) developed urinary incontinence. After multivariate analysis, the risk factors of urinary incontinence after closure of vesicovaginal fistula were: the patient’s age, the anatomical type III, iterative surgical intervention, the brevity of the urethra and decrease in bladder capacity. Conclusion: Urinary incontinence after closure of vesicovaginal fistula is a frequent problem in Guinea, the prevention of which should be integrated into the management of fistulas.

Ten-Year Outcomes of Transobturator Mid-Urethral Sling for Treatment of Stress Urinary Incontinence in Hong Kong Chinese Women with or without Reconstructive Pelvic Floor Surgery

Objective: To evaluate the outcomes of transobturator mid-urethral sling (TO-MUS) with or without reconstructive pelvic floor surgery (RPFS) in Chinese women with stress urinary incontinence (SUI) after 10 years. Methods: This was a prospective observational study on Chinese women undergoing the insertion of TO-MUS with or without RPFS. All patients were assessed at 1-year and 10-year by urodynamic study (UDS). Objective cure was defined as the absence of urine leakage during provocative maneuvers on filling cystometry. Data regarding subjective outcome (patient perception), quality of life changes (Urogenital Distress Inventory-short form (UDI-6), Incontinence Impact Questionnaire-short form (IIQ-7)) and adverse events were also collected. Results: Of 104 eligible patients, 99 patients completed the 10-year evaluation. 57 patients (57.6%) underwent TO-MUS only and 42 patients (42.4%) underwent TO-MUS with concomitant RPFS. At 10-year follow-up, the overall objective cure rate was 86.9% and overall subjective cure rate was 80.8%. In TO-MUS only group, the objective and subjective cure rates at 10-year were 84.2% and 78.9% respectively. In TO-MUS with RPFS group, the objective and subjective cure rates at 10-year were 90.5% and 83.3% respectively. Compared TO-MUS only group with TO-MUS with RPFS group, there were no statistically significant differences in objective cure rate (84.2% vs. 90.5%, p = 0.55) and subjective cure rate (78.9% vs. 83.3%, p = 0.58). Conclusion: TO-MUS is an effective treatment for SUI in Hong Kong Chinese women. Concomitant RPFS during the procedure of TO-MUS does not affect the success.

Female Stress Urinary Incontinence Treatment by Forming an Uretro-Vesical Angle with or without Mesh

Objective: To evaluate, in a comprehensive way, mesh and mesh free SUI treatment results obtained in a single center. The present study addresses the efficacy and safety of a novel surgical technique. Material & Methods: Adult female SUI patients, 184 in total, were divided within a sequential manner into two groups to be treated for SUI either with or without mesh insertion during a surgical intervention. In this novel procedure, a vertical vaginal incision from the urethra towards the bladder bottom is made and closed transversely. After the intervention the patients revisited the clinic at the 6th month. Results: 81 patients in mesh and 83 in the mesh free group completed the 2-year follow up. Based on the pad tests conducted at the end of 24-month follow up, 82% of the patients in the mesh free group and 85% in the mesh group were considered as successful if the pad test resulted with ≤2 gram. Cystocele of Grade I or II was also treated in 69 patients within the same single surgical procedure. Conclusion: The surgical outcomes of the mesh and mesh-free group were almost the same. However, though the cure rate of the mesh group was higher, it was not statistically significant. Adverse events were more frequent in the mesh group due to mesh presence.

Correlation of pelvic floor ultrasound parameter with extracellular matrix remodeling and apoptosis in patients with stress urinary incontinence

Objective: To study the correlation of pelvic floor ultrasound parameter with extracellular matrix remodeling and apoptosis in patients with stress urinary incontinence. Methods:Patients with stress urinary incontinence who underwent surgical treatment in Tianmen First People's Hospital in Hubei Province between March 2015 and August 2017 were selected as the SUI group of the research and patients who underwent total hysterectomy due to benign uterine lesions in Tianmen First People's Hospital in Hubei Province over the same period were selected as the control group of the research. Pelvic floor ultrasonography was done before surgery to measure the bladder neck descent (BND), and pelvic floor tissue was collected after surgery to determine the contents of Col-I, Col-III, TGF-β1, MMP1, MMP9, TIMP1, E-cadherin, Bax, Bcl-2, Bcl-xL, Caspase-3 and HIF-1 . Results: The pelvic floor ultrasound parameter BND of SUI group was significantly higher than that of control group;Col-I, Col-III, TIMP1, E-cadherin, Bcl-2 and Bcl-xL contents in the pelvic floor tissue of SUI group were significantly lower than those of control group whereas TGF-β1, MMP1, MMP9, Bax, Caspase-3 and HIF-1 contents were significantly higher than those of control group;Col-I, Col-III, TIMP1, E-cadherin, Bcl-2 and Bcl-xL contents in the pelvic floor tissue of SUI group of patients with high BND were significantly lower than those of patients with low BND whereas TGF-β1, MMP1, MMP9, Bax, Caspase-3 and HIF-1 contents were significantly higher than those of patients with low BND. Conclusion: The change of pelvic floor ultrasound parameter BND in patients with stress urinary incontinence is closely related to the extracellular matrix remodeling and apoptosis in pelvic floor tissue.

Study on relationship of apolipoprotein E gene polymorphism and genetic susceptibility of stress urinary incontinence

Objective:To explore the relationship between apolipoprotein E(ApoE) gene polymorphism and susceptibility of stress urinary incontinence(SUI). Methods:ApoE genotypes were examined by polymerase chain reaction-restricted fragment length polymorphism (PCR-RFLP) technique in 99 patients with SUI and 101 asymptomatic controls. Results:The frequency of allele e3 of ApoE was slightly lower in patients with anatomic SUI than that in controls (79.44%vs.81.68%),while the frequency of allele e4 of ApoE was slightly higher in patients with anatomic SUI than that in controls(10.00%vs.9.90%).No significant difference was found in frequency of allele e3 or e4 between SUI patients and controls(x^2=0.523,P = 0.770). Conclusion:The gene polymorphism of ApoE is not independently involved in the development of SUI.

Efficacy of biofeedback on stress urinary incontinence in women receiving pelvic floor muscle training: a meta-analysis

Background:To systematically evaluate the effect of pelvic floor muscle training with biofeedback v.s.pelvic floor muscle exercise alone on stress urinary incontinence in women.Methods:PubMed,the Cochrane Library,Web of Science,Ovid,Ebsco,PEDro,WanFang Data,VIP and CNKI databases were electronically searched to collect randomized controlled trials that meet inclusion criteria.After quality assessment,meta-analysis was conducted by RevMan 5.3 software.Results:A total of 8 randomized controlled trials were included.The results of meta-analysis supported the effectiveness of biofeedback on improving pelvic floor muscle strength(MD=4.67,95%CI(1.86,7.49),P=0.001),increasing short(up to 1 hour)pad test(SMD=−1.11,95%CI(−1.84,−0.37),P=0.003),enhancing quality of life(SMD=−0.34,95%CI(−0.67,−0.01),P=0.04)and social activity index(MD=0.1,95%CI(0.06,0.15),P<0.001).Conclusion:Pelvic floor muscle training with biofeedback could improve pelvic floor muscles’strength and help these patients integrate into society,more high quality studies are required to verify above conclusions.

Urinary incontinence following obstetric fistula repair

Prolonged and/or obstructed labour is the most common cause of genital tract fistula world-wide, in particular, sub-Saharan Africa and parts of Asia where emergency obstetric services are unavailable or suboptimal to afford timely delivery of the baby. This results in pressure necrosis by the fetal presenting part at the level of the obstruction in the maternal pelvis. Other reasons for obstetric fistula include trauma from vaginal deliveries(spontaneous or instrumental) and iatrogenic from cesarean section/hysterectomy. The majority of women develop the fistula during their first labour and most babies are stillborn. Women with a fistula suffer from leakage of urine and/or faeces from the vagina and surgery is the treatment for an established fistula. Longterm complications of fistulas include recurrent fistula, urinary incontinence, reproductive dysfunction, sexual dysfunction, mental health dysfunction, social isolation and orthopaedic complications such as footdrop. Ongoing urinary symptoms are not uncommon after successful fistula closure. There are various reasons for residual urinary incontinence following obstetric fistula repair including urinary stress incontinence, overactive bladder, mixed urinary incontinence and voiding dysfunction. Urinary incontinence after fistula repair requires careful evaluation prior to further surgery, as in some diagnoses, continence surgery is unlikely to treat and may worsen the condition. Initial results from educational and physiotherapy programs demonstrated a positive impact on post-fistula incontinence.

Nursing Staff’s Experiences of Providing Toilet Assistance to Elderly Nursing Home Residents with Urinary Incontinence

Introduction: Urinary incontinence is a common condition among elderly. It affects their daily life and quality of life. Toilet assistance may decrease urinary incontinence episodes among elderly. Many nursing home residents do not receive the available evidence-based toilet assistance they need. Aim: The aim of the present study was to describe nursing staff members’ experiences of providing toilet assistance to elderly nursing home residents with urinary incontinence. Design: A descriptive design with a qualitative content analysis method was used. Method: Four nurses and seven auxiliary nurses were interviewed in three homogenous focus groups. Data were collected during spring 2015. Results: The most essential opportunity factor for good toilet assistance was the nursing staff’s attitude and behavior regarding the elderly’s need to visit the lavatory. This resulted in individual toilet assistance in which the elderly’s integrity and needs were cared for. Functioning routines and sufficient staff availability were crucial in determining whether the elderly could visit the lavatory. Other enabling factors for good toilet assistance were information and education of staff. The main obstructing factors for good toilet assistance were the elderly’s decreased cognitive ability, negative attitudes toward receiving toilet assistance and lack of communication and co-operation between professionals with regard to prescribing and fastening individual incontinence aids. Conclusion: Providing toilet assistance is a considerable nursing intervention for elderly to help them regain continence or contain incontinence, whenever possible. Person-centered incontinence care is important for developing and adjusting toilet assistance based on each older person’s individual needs.