Study Type – Symptom prevalence (prospective cohort)

Level of Evidence 1b

What’s known on the subject? and What does the study add?

Few prevalence studies used current ICS LUTS symptom definitions and to our knowledge no studies exist that estimate total worldwide prevalence of reported LUTS symptoms One of the primary goals of this analysis was to estimate current and future worldwide prevalence of LUTS among adults Our estimation model suggests that LUTS are highly prevalent worldwide, with an increasing burden predicted over time

OBJECTIVE
• To estimate and predict worldwide and regional prevalence of lower urinary tract symptoms (LUTS), overactive bladder (OAB), urinary incontinence (UI) and LUTS suggestive of bladder outlet obstruction (LUTS/BOO) in 2008, 2013 and 2018 based on current International Continence Society symptom definitions in adults aged ≥20 years

PATIENTS AND METHODS
• Numbers and prevalence of individuals affected by each condition were calculated with an estimation model using gender- and age-stratified prevalence data from the EPIC study along with gender- and age-stratified worldwide and regional population estimates from the US Census Bureau International Data Base

RESULTS
• An estimated 452%, 107%, 82% and 215% of the 2008 worldwide population (43 billion) was affected by at least one LUTS, OAB, UI and LUTS/BOO, respectively By 2018, an estimated 23 billion individuals will be affected by at least one LUTS (184% increase), 546 million by OAB (201%), 423 million by UI (216%) and 11 billion by LUTS/BOO (185%)

• The regional burden of these conditions is estimated to be greatest in Asia, with numbers of affected individuals expected to increase most in the developing regions of Africa (301–311% increase across conditions, 2008–2018), South America (205–247%) and Asia (197–244%)

CONCLUSIONS
• This model suggests that LUTS, OAB, UI and LUTS/BOO are highly prevalent conditions worldwide Numbers of affected individuals are projected to increase with time, with the greatest increase in burden anticipated in developing regions

• There are important worldwide public-health and clinical management implications to be considered over the next decade to effectively prevent and manage these conditions

https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1464-410X.2010.09993.x

Worldwide prevalence estimates of lower urinary tract symptoms, overactive bladder, urinary incontinence and bladder outlet obstruction

The US Food and Drug Administration (FDA) regulates medical devices primarily through the law known as the Federal Food, Drug, and Cosmetic Act, as Amended (“the FD&C Act,” or “the Act”). Regulations promulgated by FDA in Title 21 of the Code of Federal Regulations (CFR) spell out the broad provisions contained in the Act.

United States food and drug administration

OBJECTIVE
The purpose of this study was to describe the distribution of pelvic organ support in a gynecologic clinic population to define the clinical disease state of pelvic organ prolapse and to analyze its epidemiologic condition.


STUDY DESIGN
This was a multicenter observational study. Subjects who were seen at outpatient gynecology clinics who required an annual gynecologic examination underwent a pelvic organ prolapse quantification examination and completed a prolapse symptom questionnaire. Receiver operator characteristic curves were used to define pelvic organ prolapse with the use of symptoms and pelvic organ prolapse quantification examination measures. Standard age-adjusted univariate and multivariate logistic regression analysis were used to evaluate various relationships.


RESULTS
The population consisted of 1004 women who were aged 18 to 83 years. The prevalence of pelvic organ prolapse quantification stages was 24% (stage 0), 38% (stage 1), 35% (stage 2), and 2% (stage 3). The definition of pelvic organ prolapse that was determined by the receiver operator characteristic curve was the leading edge of their vaginal wall that was -0.5 cm above the hymenal remnants. Multivariate analysis revealed age, Hispanic race, increasing body mass index, and the increasing weight of the vaginally delivered fetus as risk factors for pelvic organ prolapse, as defined in this population.


CONCLUSION
The results from this population suggest that there is a bell-shaped distribution of pelvic organ support in a gynecologic clinic population. Advancing age, Hispanic race, increasing body mass index, and the increasing weight of the vaginally delivered fetus have the strongest correlations with prolapse.

Iconographies supplémentaires de l'article : Pelvic Organ Support Study (POSST): The distribution, clinical definition, and epidemiologic condition of pelvic organ support defects

Urinary incontinence in women

Antibiotics for asymptomatic bacteriuria in pregnancy.

https://obgyn.onlinelibrary.wiley.com/doi/pdf/10.1016/S0020-7292%2803%2900220-0

Urinary incontinence as a worldwide problem

Urinary tract infections (UTIs) are one of the most frequent clinical bacterial infections in women, accounting for nearly 25% of all infections. Around 50-60% of women will develop UTIs in their lifetimes. Escherichia coli is the organism that causes UTIs in most patients. Recurrent UTIs (RUTI) are mainly caused by reinfection by the same pathogen. Having frequent sexual intercourse is one of the greatest risk factors for RUTIs. In a subgroup of individuals with coexisting morbid conditions, complicated RUTIs can lead to upper tract infections or urosepsis. Although the initial treatment is antimicrobial therapy, use of different prophylactic regimens and alternative strategies are available to reduce exposure to antibiotics.

/pdf/recurrent-urinary-tract-infections-management-in-women-a-526juydx8h.pdf

Recurrent Urinary Tract Infections Management in Women: A review.

Prevalence of urinary incontinence among Saudi women

This study compared the incidence, duration, and predictors of early postoperative voiding dysfunction (VD) after three continence operations. Charts of women undergoing tension-free vaginal tape (TVT), Burch, or suburethral sling were reviewed. Early postoperative VD was defined as urinary retention or postvoid residual (PVR) >200 ml at discharge. Analysis of variance, Chi-square, and non-parametric tests were used. Sixty-three TVT, 42 Burch and 33 slings were identified. Incidence of VD with TVT, sling, and Burch was 50, 24, and 15%, respectively ( P<0.001), and the mean number of days of postoperative catheter use was 9, 21, and 5 days, respectively ( P=0.04). Patients with VD, compared with those with normal voiding, had smaller preoperative PVR (50 vs. 75 ml, P=0.005), longer catheterization (29 vs. 3 days, P<0.001), and more urinary tract infections (43 vs. 15%, P<0.001). Early postoperative VD is an underreported but frequent postoperative complication which is difficult to predict.

Tension-free vaginal tape, Burch, and slings: are there predictors for early postoperative voiding dysfunction?

Stress urinary incontinnce (SUI) is a common condition among women. The usual approach to treatment of SUI is a stepwise plan from conservative to surgical procedures. A vaginal pessary is one of the commonly used conservative treatments that offer symptomatic improvement for women with incontinence. This review provides a critical analysis of the benefits and shortcomings offered by vaginal pessaries to patients affected by SUI, with a particular focus on indications, advantages, quality of life, patient satisfaction, and potential complications. To obtain the required information, an extensive search of PubMed and Cochrane databases was performed, covering the time frame from January 2000 to December 2016. We also surveyed the published guidelines of American Urological Association, Canadian Urological Association, American Urogynecological Society, National Institutes of Health (USA), and National Institute for Health and Care Excellence (UK). A total of 192 original research papers, review articles, and clinical trials were identified. The analysis of retrieved data provides evidence that vaginal pessaries constitute an effective nonsurgical option for SUI. The satisfaction rate with pessary use is high and only minor complications, if any, occur, vaginal discharge being the most common. The reviewed studies document that vaginal pessaries provide an adequate control of SUI if they are fit properly and managed by frequent replacements and regular checkups. They should be considered among the first line of treatment for SUI associated with exercise and increased intra-abdominal pressure.

/pdf/pessary-use-in-stress-urinary-incontinence-a-review-of-oiai7vjzd2.pdf

Ahmed Al-Badr

Papers

Urinary incontinence as a worldwide problem

Recurrent Urinary Tract Infections Management in Women: A review.

Prevalence of urinary incontinence among Saudi women

Tension-free vaginal tape, Burch, and slings: are there predictors for early postoperative voiding dysfunction?

Pessary use in stress urinary incontinence: a review of advantages, complications, patient satisfaction, and quality of life