nach oben

International Urogynecology Journal

Erschienen in:

01.05.2009 | Original Article

Predictors of outcomes in the treatment of urge urinary incontinence in women

verfasst von: Holly E. Richter, Kathryn L. Burgio, Toby C. Chai, Stephen R. Kraus, Yan Xu, Lee Nyberg, Linda Brubaker

Erschienen in: International Urogynecology Journal | Ausgabe 5/2009

Einloggen, um Zugang zu erhalten

Abstract

Introduction and hypothesis

Women with urge predominant urinary incontinence received active intervention (drug therapy alone or combined with behavioral therapy) for 10 weeks, then stopped all therapy and were followed for 6 months more. In this planned secondary analysis, we aimed to identify predictors of therapeutic success at 10 weeks (≥70% reduction in incontinence) and of ability to discontinue treatment and sustain improvements 6 months later.

Methods

Using data from 307 women, we performed logistic regression to identify predictors for outcomes described above.

Results

After controlling for group, only younger age was associated with short-term success (OR 0.8, 95% CI 0.66, 0.96). At 6 months, controlling for group and short-term outcome, only greater anterior vaginal wall prolapse was associated with successful discontinuation (POP-Q point Aa; OR 1.33, 95% CI 1.03, 1.7).

Conclusion

These findings are not of sufficient strength to justify withholding conservative therapies but might be used to promote realistic expectations when counseling patients.

Nur mit Berechtigung zugänglich

Burgio KL, Whitehead WE, Engel BT (1985) Urinary incontinence in the elderly: Bladder-sphincter biofeedback and toileting skills training. Ann Intern Med 104:507–515

Fantl JA, Wyman JF, McClish DK, Harkins SW, Elswick RK, Taylor JR et al (1991) Efficacy of bladder training in older women with urinary incontinence. JAMA 265:609–613PubMedCrossRef

McDowell BJ, Burgio KL, Dombrowski M, Locher JL, Rodriguez E (1992) Interdisciplinary approach to the assessment and behavioral treatment of urinary incontinence in geriatric outpatients. J Am Geriatr Soc 40:370–374PubMed

Burgio KL, Goode PS, Locher JL, Richter HE, Roth DL, Wright KC et al (2003) Predictors of outcome in the behavioral treatment of urinary incontinence in women. Obstet Gynecol 102:940–947PubMedCrossRef

Cammu H, Van Nylen M (1995) Pelvic floor muscle exercises: 5 years later. Urology 45:113–118PubMedCrossRef

Wyman JF, Fantl JA, McClish DK, Bump RC (1998) Comparative efficacy of behavioral interventions in the management of female urinary incontinence. The Continence Program for Women Research Group. Am J Obstet Gynecol 179:999–1007PubMedCrossRef

Subak LL, Quesenberry CP, Posner SF, Cattolica E, Soghikian K (2002) The effect of behavioral therapy on urinary incontinence: a randomized controlled trial. Obstet Gynecol 100:72–78PubMedCrossRef

Michel MC, Schneider T, Krege S, Goepel M (2002) Does gender or age affect the efficacy and safety of tolterodine? J Urol 168:1027–1031PubMedCrossRef

Zinner NR, Mattiasson A, Stanton SL (2002) Efficacy, safety and tolerability of extended-release once-daily tolterodine treatment for overactive bladder in older versus young patients. J Am Geriatr Soc 50:799–807PubMedCrossRef

10.

Karram MM, Partoll L, Rahe J (1996) Efficacy of nonsurgical therapy for urinary incontinence. J Reprod Med 40:215–219

11.

Weinberger MW, Goodman BM, Carnes M (1999) Long-term efficacy of nonsurgical urinary incontinence treatment in elderly women. J Geront 54A(3):M117–M121

12.

Burgio KL, Kraus SR, Menefee S, Borello-France D, Corton M, Johnson HW, for Urinary Incontinence Treatment Network et al (2008) Behavioral therapy to enable women with urge incontinence to discontinue drug treatment. Ann Internal Med 149:161–169

13.

Urinary Incontinence Treatment Network (UITN) (2007) Design of the Behavior Enhances Drug Reduction of Incontinence (BE-DRI) Study. Contemp Clin Trials 28:48–58CrossRef

14.

Herzog AR, Diokno AC, Brown MB, Normolle DP, Brock BM (1990) Two-year incidence, remission and change patterns of urinary incontinence in Noninstitutionalized older adults. J Gerontol 45:M67–M74PubMed

15.

Brink CA, Wells TJ, Sampselle CM, Taille ER, Mayer R (1994) A digital test for pelvic muscle strength in women with urinary incontinence. Nurs Res 43:352–356PubMedCrossRef

16.

Bump RC, Mattiasson A, Bo K et al (1996) The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol 175:10–17PubMedCrossRef

17.

Burgio KL, Locher JL, Goode PS, Hardin JM, McDowell BJ, Dombrowski M et al (1998) Behavioral vs drug treatment for urge urinary incontinence in older women: a randomized controlled trial. JAMA 280:1995–2000PubMedCrossRef

18.

Burgio KL, Goode PS, Richter HE, Locher JL, Roth DL (2006) Global ratings of patient satisfaction and perceptions of improvement with treatment for urinary incontinence: validation of three global patient ratings. Neurolurol Urodyn 25:411–417CrossRef

19.

Shumaker SA, Wyman JF, Uebersax JS, McClish D, Fantl JA (1994) Health-related quality of life measures for women with urinary incontinence: the incontinence impact questionnaire and the urogenital distress inventory. Continence Program in Women (CPW) Research Group. Qual Life Res 3:291–306PubMedCrossRef

20.

Coyne KA (2002) Summary of the Validation of the QAB-q: A Disease-Specific Overactive Bladder Questionnaire. Report for Pharmacia Corporation. MEDTAP International, Bethesda, MD

21.

Ware J Jr, Kosinski M, Keller SD (1996) A 12-Item Short-Form Health Survey: construction of scale, and preliminary tests of reliability and validity. Med Care 34:220–233PubMedCrossRef

22.

Kenton K, Lowenstein L, Simmons J, Brubaker L (2007) Aging and overactive bladder may be associated with loss of urethral sensation in women. Neurourol Urodynam 26:981–984CrossRef

23.

Shafik A, Shafik IA, El Sibai O, Shafik AA (2007) Effect of urethral stimulation on vesical contractile activity. Am J Med Sci 334:240–243PubMedCrossRef

24.

Yoshida M, Miyamae K, Iwashita H, Otani M, Inadome A (2004) Management of detrusor dysfunction in the elderly: changes in acetylcholine and adenosine triphosphate release during aging. Urology 63:17–23PubMedCrossRef

25.

Digesu GA, Salvatore S, Chaliha C, Athanasiou S, Milani R, Khullar V (2007) Do overactive bladder symptoms improve after repair of anterior vaginal wall prolapse? Int Urogynecol J Pelvic Floor Dysfunct 18:1439–1443PubMedCrossRef

26.

Foster RT Sr, Barber MD, Parasio MF, Walters MD, Weidner AC, Amundsen CL (2007) A prospective assessment of overactive bladder symptoms in a cohort of elderly women who underwent transvaginal surgery for advanced pelvic organ prolapse. Am J Obstet Gynecol 197:82.e1–82.e4CrossRef

27.

Burgio KL, Nygaard IE, Richter HE, Brubaker L, Gutman RE, Leng W, for the Pelvic Floor Disorders Network et al (2007) Bladder symptoms one year after abdominal sacrocolpopexy with and without burch colposuspension in women without preoperative stress incontinence. Am J Obstet Gynecol 194:647–649

28.

Brubaker L, Nygaard I, Richter HE, Visco A, Weber AM, Cundiff GW, for the Pelvic Floor Disorders Network et al (2008) Two-year outcomes following sacrocolpopexy with and without burch to prevent stress urinary incontinence. Obstet Gynecol 112:49–55PubMed

29.

Jung SY, Fraser MO, Ozawa H, Yokoyama O, Yoshiyama M, De Groat WC et al (1999) Urethral afferent nerve activity affects the micturition reflex; implication for the relationship between stress incontinence and detrusor instability. J Urol 162:204–212PubMedCrossRef

30.

Burrows LJ, Meyn LA, Walters MD, Weber AM (2004) Pelvic symptoms in women with pelvic organ prolapse. Obstet Gynecol 104:982–988PubMed

Titel: Predictors of outcomes in the treatment of urge urinary incontinence in women
verfasst von: Holly E. Richter
Kathryn L. Burgio
Toby C. Chai
Stephen R. Kraus
Yan Xu
Lee Nyberg
Linda Brubaker
Publikationsdatum: 01.05.2009
Verlag: Springer-Verlag
Erschienen in: International Urogynecology Journal / Ausgabe 5/2009
Print ISSN: 0937-3462
Elektronische ISSN: 1433-3023
DOI: https://doi.org/10.1007/s00192-009-0805-1

Neu im Fachgebiet Gynäkologie und Geburtshilfe

Ambulantisierung: Erste Erfahrungen mit dem Hybrid-DRG

02.05.2024 DCK 2024 Kongressbericht

Die Hybrid-DRG-Verordnung soll dazu führen, dass mehr chirurgische Eingriffe ambulant durchgeführt werden, wie es in anderen Ländern schon länger üblich ist. Die gleiche Vergütung im ambulanten und stationären Sektor hatten Niedergelassene schon lange gefordert. Aber die Umsetzung bereitet ihnen doch Kopfzerbrechen.

Sind Frauen die fähigeren Ärzte?

30.04.2024 Gendermedizin Nachrichten

Patienten, die von Ärztinnen behandelt werden, dürfen offenbar auf bessere Therapieergebnisse hoffen als Patienten von Ärzten. Besonders gilt das offenbar für weibliche Kranke, wie eine Studie zeigt.

Harninkontinenz: Netz-Op. erfordert über lange Zeit intensive Nachsorge

30.04.2024 Harninkontinenz Nachrichten

Frauen mit Belastungsinkontinenz oder Organprolaps sind nach einer Netz-Operation keineswegs beschwerdefrei. Vielmehr scheint die Krankheitslast weiterhin hoch zu sein, sogar höher als von harninkontinenten Frauen, die sich nicht haben operieren lassen.

Welche Übungen helfen gegen Diastase recti abdominis?

30.04.2024 Schwangerenvorsorge Nachrichten

Die Autorinnen und Autoren einer aktuellen Studie aus Griechenland sind sich einig, dass Bewegungstherapie, einschließlich Übungen zur Stärkung der Bauchmuskulatur und zur Stabilisierung des Rumpfes, eine Diastase recti abdominis postpartum wirksam reduzieren kann. Doch vieles ist noch nicht eindeutig belegt.

Update Gynäkologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert – ganz bequem per eMail.

Newsletter bestellen

Springer Medizin

Abstract

Introduction and hypothesis

Methods

Results

Conclusion

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 5/2009

Nerve injury during uterosacral ligament fixation: a cadaver study

Classification of female genito-urinary tract fistula: a comprehensive review

Rectovaginal fistulography: a technique for the identification of recurrent elusive fistulas

Estrogen replacement avoids the decrease of bladder innervations in ovariectomized adult virgin rats: in vivo stereological study