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Purpose To examine the effect of pregnancy pilates-assisted birth preparation training on urinary incontinence (UI) including stress urinary incontinence (SUI) and urge urinary incontinence (UUI) during pregnancy, and the postpartum period and birth outcomes. Method In this single-center, single-blind, randomized, controlled study, 126 participants who have 28–30 weeks of gestation and nulliparous were randomly assigned to receive either the ( n  = 63) or control group ( n  = 63). The study was carried out between March and August 2022. Pregnancy pilates intervention was applied twice in a week, a total of 8 weeks to pilates group. The control group was given routine obstetric and pregnancy care. A personal data form and the Michigan Incontinence Severity Index Form (M-ISI) were used as data collection tools. Results The mean weight gains of the experimental group during pregnancy were significantly lower than the control group. The experimental group had almost twice the rate of vaginal birth than those of the control group. The duration of labor mean score of experimental group was 5 h and 43 min less than the duration of labor of the control group ( p  < 0.001). After intervention, and postpartum period, the SUI and UUI severity of the experimental group was significantly lower than those of the control group ( p  < 0.001). Conclusion Pilates-assisted childbirth preparation training reduced the severity of UI including SUI and UUI symptoms during pregnancy and the early postpartum. In addition, pilates-assisted childbirth preparation training contributes to decrease in weight gain during pregnancy, the increase in the vaginal birth rate, and the shortening of the duration of labor. Trial registration NCT06185439

ObjectiveStress urinary incontinence (SUI) is common among females during functional fitness training, such as CrossFit. The aim of this study was to assess the effect of pelvic floor muscle training (PFMT) on SUI in female functional fitness exercisers.MethodsThis was an assessor-blinded randomised controlled trial with a PFMT group (n=22) and a control group (n=25). The PFMT group followed a 16-week home-training programme with 3 sets of 8–12 maximum pelvic floor muscle (PFM) contractions daily and weekly follow-up/reminders by phone. The primary outcome was change in a total score of the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI-SF). The secondary outcomes were perceived change of symptoms of SUI, change of PFM strength measured by vaginal manometry and symptoms of anal incontinence (AI) and pelvic organ prolapse (POP).Results47 women, mean age of 33.5 years (SD: 8.1), participated. At 16 weeks, there was a mean difference between groups of −1.4 (95% CI: −2.6 to −0.2) in the change of the ICIQ-UI-SF score in favour of the PFMT group. The PFMT group completed a mean of 70% (SD: 23) of the prescribed protocol. 64% in the PFMT group versus 8% in the control group reported improved symptoms of SUI (p<0.001, relative risk: 7.96, 95% CI, 2.03 to 31.19). There were no group differences in the change of PFM strength or AI/POP symptoms.ConclusionA 16-week home-training programme of the PFM led to improvements in SUI in female functional fitness exercisers. However, PFM strength and AI and POP symptoms did not improve significantly in the PFMT group compared with the control group.

This trial assessed the utility of preoperative urodynamic testing in women with uncomplicated stress–predominant urinary incontinence. Women having office evaluation alone had 1-year treatment-success rates noninferior to those of women also having urodynamic testing. In the United States in 2010, approximately 260,000 women underwent surgical treatment of stress urinary incontinence. 1 Urodynamic studies, which assess physiological variables during bladder storage and emptying, are often performed preoperatively to confirm and characterize the clinical features of stress urinary incontinence or to guide decisions about modifications in treatment. 2 – 4 However, these studies have not been shown to improve surgical outcomes, they are uncomfortable and costly (payments allowed by Medicare are greater than $500 for the three-part study), 5 and they increase the risk of urinary tract infection. 6 A Cochrane review 7 and the National Institute for Health and Clinical Excellence . . .

Urinary incontinence symptoms are highly prevalent among women, have a substantial effect on health-related quality of life and are associated with considerable personal and societal expenditure. Two main types are described: stress urinary incontinence, in which urine leaks in association with physical exertion, and urgency urinary incontinence, in which urine leaks in association with a sudden compelling desire to void. Women who experience both symptoms are considered as having mixed urinary incontinence. Research has revealed overlapping potential causes of incontinence, including dysfunction of the detrusor muscle or muscles of the pelvic floor, dysfunction of the neural controls of storage and voiding, and perturbation of the local environment within the bladder. A full diagnostic evaluation of urinary incontinence requires a medical history, physical examination, urinalysis, assessment of quality of life and, when initial treatments fail, invasive urodynamics. Interventions can include non-surgical options (such as lifestyle modifications, pelvic floor muscle training and drugs) and surgical options to support the urethra or increase bladder capacity. Future directions in research may increasingly target primary prevention through understanding of environmental and genetic risks for incontinence. Urinary incontinence symptoms in women are prevalent and substantially affect health-related quality of life. These issues are compounded by the limited attention that urinary incontinence receives at the policy or research-funding levels. Despite these challenges, the field has witnessed considerable innovations in practice over the past decade, which are summarized in this Primer.

Introduction and hypothesis Prior studies demonstrate mixed results on the impact of obesity on the success of midurethral slings (MUS), with little known about how postoperative weight change affects outcomes. We aimed to examine the effect of postoperative weight change on outcomes 12 months after MUS for stress urinary incontinence (SUI). Methods This secondary analysis utilized data from two multicenter randomized trials of women undergoing MUS placement. Subjects were categorized into cohorts based on change in body weight at 12 months postoperatively: weight gain (≥5% increase); weight loss (≥5% decrease), and weight stable (<5% change). The primary outcome was SUI cure (no SUI episodes in a 3-day bladder diary). Patients with mixed urinary incontinence (MUI) were analyzed for changes in daily average urge incontinence (UUI) episodes in a 3-day diary. Penalized logistic regression assessed the impact of demographic and perioperative variables on the primary outcome. Results Of the 918 women included, 635 (70%) were weight stable, 144 (15%) had weight gain, and 139 (15%) had weight loss. Patients in the weight loss cohort had a higher smoking rate and a higher baseline body mass index (SD 0.29, 2.7 respectively). All cohorts experienced high SUI cure rates ranging from 77 to 81%, with no significant difference in SUI cure between cohorts ( p  = 0.607). Of 372 subjects with MUI, the weight loss cohort had significantly greater improvement in UUI episodes. Conclusions Weight change at 12 months postoperatively did not significantly alter efficacy of MUS for treatment of SUI. Patients with MUI who lost ≥5% body weight had significantly greater improvement in UUI episodes.

Background Stress urinary incontinence (SUI) is one of the notable problems in postpartum women. Even though Kegel’s exercise (KE) is a universally followed pelvic floor exercise for SUI, it is tough to perform as patients find it hard to identify the correct tiny muscles to contract. Co-contraction of the pelvic diaphragm during 90-90 ball balloon exercises (BBE) will work against IAP, and that produces a more controlled action of pelvic floor muscles. This study aims to compare the effectiveness of 90-90 BBE vs. KE over pelvic floor muscle strength (PFMS) and quality of life (QoL) in women with postpartum SUI. Method Eighty-six postpartum women with SUI will be screened and recruited through purposive sampling. Subjects will be divided into experimental and control groups through block randomization. The control group will receive KE along with the Knack technique (KT); meanwhile, the experimental group will receive 90/90 BBE with KT (10 repetitions, 3 sets a day, 3 days a week, 8 weeks). Outcome measures are pelvic floor muscle strength (PFMS), quality of life, 1-h pad test, and global rate of change, which will be taken at pre- and post-intervention at the 8th week, 3rd month, and 6th month follow-up. Parametric or nonparametric statistical tests will be used based on the normal distribution of data. The result will be presented in the form of a 95% confidence interval and P value. Discussion This trial will provide novel evidence comparing a commonly used exercise (Kegel’s) with the 90-90 ball and balloon exercise, a physiologically guided approach targeting pelvic floor–abdominal synergy. If effective, this intervention may offer an easier and potentially more acceptable alternative to postpartum women with stress urinary incontinence. However, the interpretation of findings should consider that the sample size estimation was based on pre–post data, which may overestimate the true effect. Clinical trial registration CTRI—Clinical Trial Registry of India (ICMR)—Reg.No: CTRI/2024/06/069047. Trial registered prospectively. Registered on 18.06.2024.

To evaluate the effectiveness of pelvic floor muscle training (PFMT) on pelvic floor muscle (PFM) function and quality of life (QoL) in women with stress urinary incontinence (SUI) and pelvic organ prolapse (POP). This study will be a randomized, controlled, parallel, and blinded clinical trial. The final sample will consist of 32 women diagnosed with SUI and cystocele (stage I and II). All volunteers will be assessed and reassessed using the same protocol: assessment form, gynecological examination, functional evaluation of PFM, and questionnaires to assess quality of life, urinary function, and sexual function. All volunteers will be evaluated for satisfaction levels post-treatment. The intervention will be PFMT, totaling 16 sessions to be conducted twice a week. Reevaluation will take place at the end of treatment and 1 month after completion of PFMT. Descriptive analysis and repeated measures ANOVA will be used for result analysis. A significance level of p<0.05 will be considered for all statistical tests. This study has been submitted to the Ethics in Research Committee of the Federal University of Rio Grande do Norte and approved under protocol number 5.826.563. It has been registered with the Brazilian Clinical Trials Registry ReBec (RBR-49p6g3t). It is expected that these studies will provide a deeper understanding of the efficacy of PFMT in women with SUI and cystocele. Additionally, it aims to provide more insights into the efficacy of PFMT prior to surgery.

Persons with profound intellectual and multiple disabilities in residential care facilities may benefit from smart continence care (SCC), which is incontinence material (IM) with integrated sensors that notify caregivers when the IM is saturated and requires changing. SCC aims to reduce weekly leakages and improve the quality of life. Given the growing demand for health care services and the decreasing workforce, it is essential to assess the cost-effectiveness and cost-utility of such technologies. This economic evaluation was conducted alongside a cluster randomized trial across 6 care organizations in the Netherlands. The incremental cost-effectiveness ratio (ICER) was expressed as the additional societal costs of SCC in relation to a reduction in weekly leakages. The incremental cost-utility ratio used Quality Adjusted Life Years measured via the EQ-5D-5L proxy 1 version. Robustness was assessed using bootstrapping, sensitivity, and subgroup analyses for variations in pricing and alternative outcomes (weekly IM changes [IMCs] and time savings). The study period was 12 weeks. The analyses included 74 participants in the regular continence care (RCC) group and 82 participants in the SCC group. Analyses were corrected for baseline differences in the time spent on continence care and utility. SCC is found to be less effective (-1.058, 95% CI -1.878 to -0.262) and more costly (US $371, 95% CI US$ -0.09 to $771) than RCC for the number of leakages as the outcome, placing the ICER in the northwest (NW; inferior) quadrant of the cost-effectiveness plane. Cost-utility analyses showed a high uncertainty, with results in both the NW and northeast quadrants. Scenario analysis suggested that the negative effect on leakages was due to implementation challenges. Sensitivity analyses showed that the supplier's new pricing model had a slight positive effect, reducing the estimated total societal costs, although uncertainty remains. SCC was estimated to effectively reduce weekly IMCs (ICER in the northeast quadrant) but did not save time (ICER in the NW quadrant). The results of this economic evaluation are not conclusive because of the mixed outcomes and a limited timeframe. SCC is ineffective in reducing the number of weekly leakages, but it does reduce the number of weekly IMCs. However, SCC was not effective in reducing time spent on continence care. Findings suggest that SCC is expected to be more expensive than RCC, although the supplier's new pricing model may decrease costs. The use of technologies such as SCC should not solely be based on cost-effectiveness and cost-utility outcomes. This technology offers value by generating data that can support personalized care. However, the realization of this added value is not guaranteed and may differ between individuals. Implementation challenges and individual variability underline the need for tailored approaches. ClinicalTrials.gov NCT05481840; https://clinicaltrials.gov/ct2/show/NCT05481840.

In patients with idiopathic normal-pressure hydrocephalus responsive to CSF drainage, shunting improved gait and balance at 3 months, but not cognition or incontinence, and was associated with some procedure-related risks.

Background Women with stress urinary incontinence (SUI) experience urine leakage with physical activity. Currently, the interventional treatments for SUI are surgical, or endoscopic bulking injection(s). However, these procedures are not always successful, and symptoms can persist or come back after treatment, categorised as recurrent SUI. There are longstanding symptoms and distress associated with a failed primary treatment, and currently, there is no consensus on how best to treat women with recurrent, or persistent, SUI. Methods A two-arm trial, set in at least 20 National Health Service (NHS) urology and urogynaecology referral units in the UK, randomising 250 adult women with recurrent or persistent SUI 1:1 to receive either an endoscopic intervention (endoscopic bulking injections) or a standard NHS surgical intervention, currently colposuspension, autologous fascial sling or artificial urinary sphincter. The aim of the trial is to determine whether surgical treatment is superior to endoscopic bulking injections in terms of symptom severity at 1 year after randomisation. This primary outcome will be measured using the patient-reported International Consultation on Incontinence Questionnaire - Urinary Incontinence - Short Form (ICIQ-UI-SF). Secondary outcomes include assessment of longer-term clinical impact, improvement of symptoms, safety, operative assessments, sexual function, cost-effectiveness and an evaluation of patients’ and clinicians’ views and experiences of the interventions. Discussion There is a lack of high-quality, randomised, scientific evidence for which treatment is best for women presenting with recurrent SUI. The PURSUIT study will benefit healthcare professionals and patients and provide robust evidence to guide further treatment and improve symptoms and quality of life for women with this condition . Trial registration International Standard Randomised Controlled Trials Number (ISRCTN) registry ISRCTN12201059. Registered on 09 January 2020