Gunnar Lose

The prevalence of urinary incontinence in women in four European countries

To determine the prevalence, type and treatment behaviour of women with urinary incontinence in four European countries.

The prevalence and bothersomeness of lower urinary tract symptoms in women 40-60 years of age.

Aim. To assess the prevalence and bothersomeness of lower urinary tract symptoms in women aged 40–60 years.

Anal and urinary incontinence in women with obstetric anal sphincter rupture

Objective To assess the long term impact of obstetric anal sphincter rupture on the frequency of anal and urinary incontinence and to identify factors to predict women at risk.

Risk factors for lower urinary tract symptoms in women 40 to 60 years of age.

Objective To determine the relationship between lower urinary tract symptoms and possible associated risk factors in women 40–60 years old. Methods In a normal population study, 502 women with lower urinary tract symptoms and 742 women with no symptoms (controls) were asked about possible associated factors. Results Four hundred eighty-seven women (97.0%) with symptoms and 564 controls (76.0%) completed the study. Stress incontinence was associated with parity (primipara odds ratio [OR] 2.2, 95% confidence interval [CI] 1.0, 4.9; para 2 OR 3.9, 95% CI 1.9, 8.0; para 3 OR 4.5, 95% CI 2.1, 9.5), use of diuretics (OR 2.2, 95% CI 1.2, 3.9), hysterectomy (OR 2.4, 95% CI 1.6, 3.7), and increased body mass index (BMI). Urge incontinence was associated with use of diuretics (OR 4.0, 95% CI 2.2, 7.1) and BMI. Urgency was associated with parity (primipara OR 1.9, 95% CI 0.9, 4.2; para 2 OR 3.0, 95% CI 1.5, 5.9; para 3 OR 3.1, 95% CI 1.5, 6.5), use of diuretics (OR 2.7, 95% CI 1.5, 4.7) and BMI. Associations between non–incontinence symptoms (except urgency) and observed factors were weak and inconsistent. Straining at stool and constipation were inversely associated with lower urinary tract symptoms. Overall, lesion of sphincter ani, episiotomy, fetal weight, physical activity, and hormonal status had minor association with lower urinary tract symptoms. Conclusion Lower urinary tract symptoms were associated positively with parity, BMI, prior hysterectomy, use of diuretics, straining at stool, and constipation.

The standardization of terminology in nocturia: report from the standardization subcommittee of the International Continence Society

P. VAN KER REBROECK 1 , P. ABRAMS 2 , D. CHAIKIN 3 , J. DONOVAN 4 , D. FONDA 5 , S. JACKSON 6 , P. JENNUM 7 , T. JOHNSON 8 , G.R. LOSE 9 , A. MATTIASSON 10 , G.L. ROBER TSON 11 and J. WEISS 12 1 Chairman of the International Continence Society Standardization Committee, Department of Urology, University Hospital Maastricht, the Netherlands, 2 Bristol Urological Institute, Southmead Hospital, Bristol, UK, 3 Morristown Memorial Hospital, Morristown NJ, and Department of Urology, Weill Medical College of Cornell University, USA, 4 Department of Social Medicine, University of Bristol, Bristol, UK, 5 Aged Care Services, Caulfield General Medical Centre, Victoria, Australia, 6 Department of Gynaecology, John Radcliffe Hospital, Oxford, UK, 7 Department of Clinical Neurophysiology, University of Copenhagen and Sleep Laboratory, Glostrup, Denmark, 8 Rehabilitation Research and Development Center, Atlanta VA Medical Centre, Georgia, USA, 9 Department of Obstetrics and Gynaecology, Glostrup County Hospital, University of Copenhagen, Denmark, 10 Department of Urology, Lund University Hospital, Lund, Sweden, 11 Northwestern University Medical School, Chicago, USA, 12 Department of Urology, Weill Medical College of Cornell University and The New York Presbyterian Hospital, New York, NY, USA

OUTCOME MEASURES FOR RESEARCH IN ADULT WOMEN WITH SYMPTOMS OF LOWER URINARY TRACT DYSFUNCTION

The purpose of this communication is to offer the clinical and research communities an initial attempt at incorporating outcome measurements within identifiable domains, as well as providing initial information as to the reliability of those measurements most commonly used. Scientific evaluation of the outcome of therapeutic interventions is based on assessment before and after treatment. However, the reliability of methods and measurements used in the evaluation is often poor or unclear, which makes interpretation of outcome difficult. The reliability of a test depends on the accuracy and reproducibility of the method. The diagnostic accuracy is determined by verifying test results against a reference (‘‘gold’’) standard that defines true disease status. The predictive value of a measure is considered the most important. Since it may be impossible to establish a final true diagnosis, reliability must in some cases be measured by reproducibility, which is determined by comparing results of repeated examinations of the same patient. 1 Reproducibility for tests where the result is given on a continuous scale may be expressed as bias with the 95% confidence limit [Bland and Altman, 1986], while for binary tests the kappa coefficient, which adjusts the observed agreement for expected chance agreement, is used [Gjørup, 1997]. Urinary incontinence is defined as ‘‘a condition in which involuntary urine loss is a social or hygienic problem and is objectively demonstrable.’’ It represents a multidimensional phenomenon with wide-reaching effects which may be quantified within various areas or domains. These areas or domains include:

A systematic review of the effects of estrogens for symptoms suggestive of overactive bladder

Objective.  To perform a systematic review of the effects of estrogen therapy on symptoms suggestive of overactive bladder (OAB) in postmenopausal women.

A Prospective Double-Blind Clinically Controlled Multicenter Trial of Sodium Pentosanpolysulfate in the Treatment of Interstitial Cystitis and Related Painful Bladder Disease

Painful bladder disease, sensory bladder disease, chronic abacterial cystitis and interstitial cystitis are ill-defined conditions of unknown etiology and pathogenesis, and, therefore, they are without any rational therapy. Pathogenetic theories concerning defects in the epithelium and/or mucous surface coat (including glycosaminoglycans) of the bladder, and theories concerning immunological disturbances predominate. Sodium pentosanpolysulfate (Elmiron) acts by substituting a defective glycosaminoglycan layer and inhibits complement reactions in inflammatory processes. We compared sodium pentosanpolysulfate versus placebo in a prospective double-blind, clinically controlled multicenter trial of 115 patients with painful bladder disease. Two protocols were used. Protocol A included 43 patients with clinically and pathologically anatomically verified interstitial cystitis (28 or more mast cells per mm.2), and protocol B included 72 patients with a painful bladder and unspecific histological findings. The patients were randomized to receive either sodium pentosanpolysulfate (200 mg. twice daily) or placebo capsules for 4 months. Before and after the trial the patients were evaluated with symptom grading, urodynamics and cystoscopy with distension and deep bladder biopsies. The results showed no difference between the pre-trial and post-trial values in the sodium pentosanpolysulfate and placebo groups in both protocols in regard to symptoms, urodynamic parameters, cystoscopic appearance and mast cell counts. A significant increase in the cystoscopically determined bladder capacity in the sodium pentosanpolysulfate group in protocol A was found. We conclude that no statistically or clinically significant effect of sodium pentosanpolysulfate was found compared to placebo in patients with painful bladder disease.

Urinary Incontinence in Elite Female Athletes and Dancers

Abstract: The aim of this study was, to determine the frequency of urinary loss in elite women athletes and dancers. Elite athletes in eight different sports, including ballet, filled in an evaluated questionnaire about urinary incontinence while participating in their sport/dancing and during daily life activities. A total of 291 women with a mean age of 22.8 years completed the questionnaire, providing a response rate of 73.9%. Overall, 151 women (51.9%) had experienced urine loss, 125 (43%) while participating in their sport and 123 (42%) during daily life. The proportion of urinary leakage in the different sports was: gymnastics 56%, ballet 43%, aerobics 40%, badminton 31%, volleyball 30%, athletics 25%, handball 21% and basketball 17%. During sport 44% had experienced leakage a few times, 46.4% now and then, and 9.6% frequently. During daily life the figures were: 61.7% a few times, 37.4% now and then, and 0.8% frequently. Of those who leaked during sport, 95.2% experienced urine loss while training versus only 51.2% during competition (P<0.001). The activity most likely to provoke leakage was jumping. Sixty per cent (91/151) occasionally wore pads or panty shields because of urine loss. Urinary leakage is common among elite athletes and dancers, particularly during training, but also during daily life activities.

Bacterial vaginosis in a cohort of Danish pregnant women: prevalence and relationship with preterm delivery, low birthweight and perinatal infections

Objective  To determine the prevalence of bacterial vaginosis (BV) in the second trimester of pregnancy in a Danish population using the Schmidt criteria and to examine whether BV was associated with subsequent preterm delivery, low birthweight or perinatal infections.