Vers une modélisation de l'incontinence urinaire des femmes

TOWARDS A MODELLING OF FEMALE URINARY INCONTINENCE Introduction: The main objective was to better understand the natural history of the female urinary incontinence (UI) through modelling of its prevalence by risk factors, while taking into account its severity and its type. A secondary objective was to work on the classification of the circumstances of urinary leakage.Methods: Data came from two telephone surveys of a representative population, The Health Barometer 2010 and Fecond; two mail surveys within the cohort GAZEL, one general and the other centred on urinary problems; and an Internet survey of adult volunteers, NutriNet-Health. We defined UI from a validated questionnaire, the ICIQ-UI-SF, and from a list of diseases. We used binomial and multinomial logistic regression models, multiple correspondence analysis and hierarchical clustering.Results: The prevalence of any UI ranged from 1.5% to 38.8%. In both representative samples it was 17.3%. The design of the survey, i.e. the sampling (representative or not), its objective (centred on general health or UI-centred), the data collection mode and UI definition (symptom-based or perception-based) were likely to change either upwards or downwards the estimates of the prevalence of UI.The most frequent circumstances were leaks during coughing, leakage before getting to the toilet and leaks during physical exercise. Women describing circumstances attributable to stress, urge or mixed types of incontinence formed a separate group from those reporting leakage circumstances attributable to other UI. Similarly, women declaring circumstances attributable to stress UI stood out from those declaring circumstances attributable to urge UI. The most discriminating circumstances to classify incontinent women were: leaks all the time, leaks during coughing, leaks during sleep and leaks after urination.In all the surveys included in our work we have identified significant associations between almost all available risk factors and incontinence, but some factors were associated with all forms of incontinence and others only with few forms. In addition, more associations were observed with severe UI (i.e. daily UI), than with weekly UI. Among UI types, we observed more significant associations with mixed UI and other UI than with stress and urge UI. The strongest associations were found for depression and obesity with almost all forms of UI. Obstetric variables were often associated with mixed UI.Conclusion: Precise estimates of UI prevalence should be based on non–UI-focused surveys among representative samples and using a validated standardised symptom-based questionnaire, as ICIQ-UI-SF, but it appears to be insufficient to define all types of UI. We found that it is possible to use the circumstances of urine leaks for identifying specific groups of incontinent women. But we need to explore to what extent the circumstances of urinary leakage have prognostic or predictive value for response to treatment. With modelling, as we took into account UI type and severity, we identified which UI modalities are related to certain risk factors and which are not.VERS UNE MODELISATION DE L’INCONTINENCE URINAIRE DES FEMMES Introduction : L’objectif principal était de mieux comprendre l’histoire naturelle de l’incontinence urinaire (IU) féminine grâce à une modélisation de sa prévalence sur ses facteurs de risque, en tenant compte de sa gravité et de ses types. Un objectif secondaire était de travailler sur la classification des circonstances des fuites urinaires.Matériel et méthodes : Nous avons utilisé les données de deux sondages téléphoniques sur une population représentative, Le Baromètre Santé 2010 (3089) et Fecond (5017) ; de deux enquêtes postales au sein de la cohorte GAZEL (3098), l’une générale et l’autre centrée sur les problèmes urinaires ; et enfin d’un sondage internet de volontaires adultes, NutriNet-Santé (85037). L’IU a été définie à partir d'un questionnaire validé, l’ICIQ-UI-SF et à partir d’une liste de problèmes de santé. Nous avons utilisé des modèles binomiaux et multinomiaux de régression logistique, des analyses de correspondances multiples et de classification ascendante hiérarchique.Résultats : La prévalence de l’IU tout venant (quel que soit son type ou sa gravité) variait de 1,5 % à 38,8 % selon les enquêtes et était égale à 17,3 % dans les 2 échantillons représentatifs. La conception de l’enquête, c’est-à-dire la nature de l’échantillon (représentatif ou non), son objectif (centré sur la santé générale ou l’IU), le mode de recueil des données et la mode de définition de l’IU (à partir d’un questionnaire spécifique validé ou basée sur une liste de maladies) étaient susceptibles de modifier à la hausse ou à la baisse les estimations de la prévalence de l’IU.Les fuites les plus fréquentes étaient les fuites à la toux, les fuites avant d’arriver aux toilettes et les fuites lors de l’exercice physique. Les femmes décrivant des circonstances attribuées aux principaux types d’IU, effort, par urgenturie et mixte, formaient un groupe distinct de celles déclarant des circonstances attribuées au type IU autre. De même, les femmes déclarant des circonstances attribuables à une IU d’effort se démarquaient de celles déclarant des circonstances attribuables à une IU par urgenturie. Les circonstances les plus discriminantes pour classer les femmes incontinentes étaient : fuites tout le temps, à la toux, pendant le sommeil et après la miction. Dans toutes les enquêtes nous avons identifié des associations significatives entre presque tous les facteurs de risque disponibles et l’incontinence ; mais certains facteurs étaient liés avec toutes les formes d’IU et d’autres seulement avec certaines formes. De plus nombreuses associations ont été observées avec l’IU grave, c’est-à-dire quotidienne, qu’avec l’IU hebdomadaire. Nous avons observé plus d’associations significatives avec l’IU mixte et l’IU autre qu’avec l’IU d’effort et l’IU par urgenturie. Les plus fortes associations ont été observées pour la dépression et l’obésité, liées avec presque toutes les formes d’IU. Les variables obstétricales étaient souvent liées à l’IU mixte. Conclusion : Le questionnaire ICIQ-UI-SF est approprié pour estimer la prévalence de l’incontinence urinaire dans des échantillons représentatifs mais il apparaît insuffisant pour définir tous les types d’IU. Nos résultats ont objectivé qu’il est possible d’utiliser les circonstances des fuites d’urine pour identifier des groupes spécifiques de femmes incontinentes, et que certaines circonstances peu utilisées en cliniques sont pourtant très discriminantes. Il y a probablement des travaux à faire et à poursuivre pour explorer dans quelle mesure les circonstances des fuites ont une valeur pronostique ou prédictive de réponse au traitement. Grâce à la modélisation, où nous avons pris en compte le type et la gravité de l’IU, nous avons pu constater quelles modalités de l’IU sont liées à certains facteurs de risque et quelles modalités ne le sont pas

What is the most effective treatment for nocturia or nocturnal incontinence in adult women?

Acknowledgments The authors express their thanks to F.C. Burkhard for invaluable logistic support during the conception of the manuscript.Peer reviewedPostprin

Medical Treatment of Nocturia in Men with Lower Urinary Tract Symptoms : Systematic Review by the European Association of Urology Guidelines Panel for Male Lower Urinary Tract Symptoms

Context: The treatment of nocturia is a key challenge due to the multi-factorial pathophysiology of the symptom and the disparate outcome measures used in research. Objective: To assess and compare available therapy options for nocturia, in terms of symptom severity and quality of life. Evidence acquisition: Medical databases (Embase, Medline, Cochrane Systematic Reviews, Cochrane Central) were searched with no date restriction. Comparative studies were included which studied adult men with nocturia as the primary presentation and lower urinary tract symptoms including nocturia or nocturnal polyuria. Outcomes were symptom severity, quality of life, and harms. Evidence synthesis: We identified 44 articles. Antidiuretic therapy using dose titration was more effective than placebo in relation to nocturnal voiding frequency and duration of undisturbed sleep; baseline serum sodium is a key selection criterion. Screening for hyponatremia (<130 mmol/l) must be undertaken at baseline, after initiation or dose titration, and during treatment. Medications to treat lower urinary tract dysfunction (alpha-1 adrenergic antagonists, 5-alpha reductase inhibitors, phosphodiesterase type 5inhibitor, antimuscarinics, beta-3 agonist, and phytotherapy) were generally not significantly better than placebo in short-term use. Benefits with combination therapies were not consistently observed. Other medications (diuretics, agents to promote sleep, nonsteroidal anti-inflammatories) were sometimes associated with response or quality of life improvement. The recommendations of the Guideline Panel are presented. Conclusions: Issues of trial designmake therapy of nocturia a challenging topic. The range of contributory factors relevant in nocturia makes it desirable to identify predictors of response to guide therapy. Consistent responses were reported for titrated antidiuretic therapy. For other therapies, responses were less certain, and potentially of limited clinical benefit. Patient summary: This review provides an overview of the current drug treatments of nocturia, which is the need to wake at night to pass urine. The symptom can be caused by several different medical conditions, and measuring its severity and impact varies in separate research studies. No single treatment deals with the symptom in all contexts, and careful assessment is essential to make suitable treatment selection. (C) 2017 European Association of Urology. Published by Elsevier B.V. All rights reserved.Peer reviewe

Modeling Urinary Incontinence in Women

VERS UNE MODELISATION DE L’INCONTINENCE URINAIRE DES FEMMES Introduction : L’objectif principal était de mieux comprendre l’histoire naturelle de l’incontinence urinaire (IU) féminine grâce à une modélisation de sa prévalence sur ses facteurs de risque, en tenant compte de sa gravité et de ses types. Un objectif secondaire était de travailler sur la classification des circonstances des fuites urinaires.Matériel et méthodes : Nous avons utilisé les données de deux sondages téléphoniques sur une population représentative, Le Baromètre Santé 2010 (3089) et Fecond (5017) ; de deux enquêtes postales au sein de la cohorte GAZEL (3098), l’une générale et l’autre centrée sur les problèmes urinaires ; et enfin d’un sondage internet de volontaires adultes, NutriNet-Santé (85037). L’IU a été définie à partir d'un questionnaire validé, l’ICIQ-UI-SF et à partir d’une liste de problèmes de santé. Nous avons utilisé des modèles binomiaux et multinomiaux de régression logistique, des analyses de correspondances multiples et de classification ascendante hiérarchique.Résultats : La prévalence de l’IU tout venant (quel que soit son type ou sa gravité) variait de 1,5 % à 38,8 % selon les enquêtes et était égale à 17,3 % dans les 2 échantillons représentatifs. La conception de l’enquête, c’est-à-dire la nature de l’échantillon (représentatif ou non), son objectif (centré sur la santé générale ou l’IU), le mode de recueil des données et la mode de définition de l’IU (à partir d’un questionnaire spécifique validé ou basée sur une liste de maladies) étaient susceptibles de modifier à la hausse ou à la baisse les estimations de la prévalence de l’IU.Les fuites les plus fréquentes étaient les fuites à la toux, les fuites avant d’arriver aux toilettes et les fuites lors de l’exercice physique. Les femmes décrivant des circonstances attribuées aux principaux types d’IU, effort, par urgenturie et mixte, formaient un groupe distinct de celles déclarant des circonstances attribuées au type IU autre. De même, les femmes déclarant des circonstances attribuables à une IU d’effort se démarquaient de celles déclarant des circonstances attribuables à une IU par urgenturie. Les circonstances les plus discriminantes pour classer les femmes incontinentes étaient : fuites tout le temps, à la toux, pendant le sommeil et après la miction. Dans toutes les enquêtes nous avons identifié des associations significatives entre presque tous les facteurs de risque disponibles et l’incontinence ; mais certains facteurs étaient liés avec toutes les formes d’IU et d’autres seulement avec certaines formes. De plus nombreuses associations ont été observées avec l’IU grave, c’est-à-dire quotidienne, qu’avec l’IU hebdomadaire. Nous avons observé plus d’associations significatives avec l’IU mixte et l’IU autre qu’avec l’IU d’effort et l’IU par urgenturie. Les plus fortes associations ont été observées pour la dépression et l’obésité, liées avec presque toutes les formes d’IU. Les variables obstétricales étaient souvent liées à l’IU mixte. Conclusion : Le questionnaire ICIQ-UI-SF est approprié pour estimer la prévalence de l’incontinence urinaire dans des échantillons représentatifs mais il apparaît insuffisant pour définir tous les types d’IU. Nos résultats ont objectivé qu’il est possible d’utiliser les circonstances des fuites d’urine pour identifier des groupes spécifiques de femmes incontinentes, et que certaines circonstances peu utilisées en cliniques sont pourtant très discriminantes. Il y a probablement des travaux à faire et à poursuivre pour explorer dans quelle mesure les circonstances des fuites ont une valeur pronostique ou prédictive de réponse au traitement. Grâce à la modélisation, où nous avons pris en compte le type et la gravité de l’IU, nous avons pu constater quelles modalités de l’IU sont liées à certains facteurs de risque et quelles modalités ne le sont pas.TOWARDS A MODELLING OF FEMALE URINARY INCONTINENCE Introduction: The main objective was to better understand the natural history of the female urinary incontinence (UI) through modelling of its prevalence by risk factors, while taking into account its severity and its type. A secondary objective was to work on the classification of the circumstances of urinary leakage.Methods: Data came from two telephone surveys of a representative population, The Health Barometer 2010 and Fecond; two mail surveys within the cohort GAZEL, one general and the other centred on urinary problems; and an Internet survey of adult volunteers, NutriNet-Health. We defined UI from a validated questionnaire, the ICIQ-UI-SF, and from a list of diseases. We used binomial and multinomial logistic regression models, multiple correspondence analysis and hierarchical clustering.Results: The prevalence of any UI ranged from 1.5% to 38.8%. In both representative samples it was 17.3%. The design of the survey, i.e. the sampling (representative or not), its objective (centred on general health or UI-centred), the data collection mode and UI definition (symptom-based or perception-based) were likely to change either upwards or downwards the estimates of the prevalence of UI.The most frequent circumstances were leaks during coughing, leakage before getting to the toilet and leaks during physical exercise. Women describing circumstances attributable to stress, urge or mixed types of incontinence formed a separate group from those reporting leakage circumstances attributable to other UI. Similarly, women declaring circumstances attributable to stress UI stood out from those declaring circumstances attributable to urge UI. The most discriminating circumstances to classify incontinent women were: leaks all the time, leaks during coughing, leaks during sleep and leaks after urination.In all the surveys included in our work we have identified significant associations between almost all available risk factors and incontinence, but some factors were associated with all forms of incontinence and others only with few forms. In addition, more associations were observed with severe UI (i.e. daily UI), than with weekly UI. Among UI types, we observed more significant associations with mixed UI and other UI than with stress and urge UI. The strongest associations were found for depression and obesity with almost all forms of UI. Obstetric variables were often associated with mixed UI.Conclusion: Precise estimates of UI prevalence should be based on non–UI-focused surveys among representative samples and using a validated standardised symptom-based questionnaire, as ICIQ-UI-SF, but it appears to be insufficient to define all types of UI. We found that it is possible to use the circumstances of urine leaks for identifying specific groups of incontinent women. But we need to explore to what extent the circumstances of urinary leakage have prognostic or predictive value for response to treatment. With modelling, as we took into account UI type and severity, we identified which UI modalities are related to certain risk factors and which are not

Mental health consequences of military sexual trauma: results from a national survey in the French military

International audienceBackground: Military sexual trauma (MST) is a major public health concern, given its prevalence and mental health sequelae. This phenomenon is particularly prevalent among women in the US military, although more cases involve men given their overrepresentation. Little is known about MST and its consequences in other military settings, including in Europe. Methods: This study draws from a national survey in the French military, including 1268 servicemen and 232 servicewomen. We conducted bivariate and multivariate analysis, using simple and multinomial logistic regressions to evaluate the associations between different forms of MST (repeated sexual comments alone/one form of sexual oppression (coercion, repeated verbal unwanted attention or assault)/ several sexual stressors) and symptoms of depression and of positive post-traumatic stress disorder (PTSD) screening scores. Results: Women were both more likely to experience MST and to experience more severe forms of MST than men. Women were also more likely than men to report mental health symptoms (31% versus 18% for symptoms of depression and 4.0% versus 1.8% for positive PTSD screening scores). Different forms of MST were associated with different levels of psychological distress. Women reporting repeated sexual comments alone had higher odds of depressive symptoms (OR=3.1 [1.7, 5.5]) relative to women with no MST. Likewise, the odds of depressive symptoms were 6.5 times higher among women and 8.0 times higher among men who experienced several sexual stressors relative to those who reported no MST. We also found higher relative risk of subthreshold PTSD screening scores among women reporting any form of sexual stressor, including sexual comments alone (RRR = 4.5 [2.8, 7.4]) and an elevenfold increase in the relative risk of positive PTSD screen scores (RRR = 11.3 [2.3, 55.6]) among women who experienced several sexual stressors relative to women with no MST. Conclusion: MST is associated with mental health distress among service members in the French military, especially for women. The heightened risk of MST coupled with psychological sequelae call for preventive programs to reduce MST and for screening programs to provide adequate psychological support

From sexual harassment to sexual assault: Prevalence and correlates of sexual trauma in the French military

International audienceBackground: Sexual harassment (SH) is prevalent in military settings and dependent on the workplace environment. Few studies have investigated this issue in non-US military settings nor have examined how contextual and individual factors related to Military Sexual Trauma (MST) vary by gender.Methods: This study draws on a national sexual survey in the French military including 1268 servicemen and 232 servicewomen. We examined four sexual stressors (repeated sexual comments, sexual coercion, repeated unwanted verbal sexual attention and sexual assault (SA)) and two combined measures of verbal SH (comments, unwanted attention) and MST (all forms). We conducted multivariate logistic regressions to identify contextual and individual factors related to these outcomes.Results: 36.7% of women and 17.5% of men experienced MST in the last year and 12.6% and 3.5% reported SA. Factors associated with verbal SH differed from those related to SA. The odds of verbal SH were elevated among men who had sex with men (OR = 3.5) and among women officers (OR = 4.6) while the odds of SA were elevated among men less than 25 years (OR = 3.5) and women with less than a high school diploma (OR = 10.9). The odds of SH increased by 20% to 80% when men worked in units with higher female representation, higher prevalence of MST (sexual comments, or sexual assault, coercion, repeated unwanted attention) and lower acceptance of women in the miliatry. The odds of SA also increased by 70% among men working in units with higher female representation and higher prevalence of sexual oppression. The odds of SA against women were particular high (OR = 5.7) in units with a high prevalence of sexual assault, coercion, or repeated unwanted attention.Conclusion: MST is common in the French military, with women experiencing more severe forms than men. Our resuls call for programmatic action to reduce workplace factors related to verbal SH and SA in the French military

Posture‐related stiffness mapping of paraspinal muscles

International audienceThe paraspinal compartment acts as a bone–muscle composite beam of the spine. The elastic properties of theparaspinal muscles play a critical role in spine stabilization. These properties depend on the subjects’ posture, andthey may be drastically altered by low back pain. Supersonic shear wave elastography can be used to providequantitative stiffness maps (elastograms), which characterize the elastic properties of the probed tissue. The aimof this study was to challenge shear wave elastography sensitivity to postural stiffness changes in healthyparaspinal muscles. The stiffness of the main paraspinal muscles (longissimus, iliocostalis, multifidus) wasmeasured by shear wave elastography at the lumbosacral level (L3 and S1) for six static postures performed byvolunteers. Passive postures (rest, passive flexion, passive extension) were performed in a first shear waveelastography session, and active postures (upright, bending forward, bending backward) with rest posture forreference were performed in a second session. Measurements were repeated three times for each posture. Sixteenhealthy young adults were enrolled in the study. Non-parametric paired tests, multiple analyses of covariance, andintra-class correlations were implemented for analysis. Shear wave elastography showed good to excellentreliability, except in the multifidus at S1, during bending forward, and in the multifidus at L3, during bendingbackward. Yet, during bending forward, only poor quality was recorded for nine volunteers in the longissimus.Significant intra- and inter-muscular changes were observed with posture. Stiffness significantly increased for theupright position and bending forward with respect to the reference values recorded in passive postures. Inconclusion, shear wave elastography allows reliable assessment of the stiffness of the paraspinal muscles except inthe multifidus at S1 and longissimus, during bending forward, and in the multifidus at L3, during bendingbackward. It reveals a different biomechanical behaviour for the multifidus, the longissimus, and the iliocostalis

Monitoring of erectile and urethral sphincter dysfunctions in a rat model mimicking radical prostatectomy damage.

International audienceIntroduction. Animal models of urinary incontinence and erectile dysfunction following radical prostatectomy (RP) are lacking. Aims. To develop an animal model of combined post-RP urethral sphincter and erectile dysfunctions, and noninvasive methods to assess erectile function (EF) and urinary sphincter function (USF) during prolonged follow-up. Methods. In the main experiments, 60 male Sprague Dawley rats were randomized to a sham operation (N = 30) or electrocautery of both sides of the striated urethral sphincter (N = 30). EF and USF were evaluated preoperatively and on postoperative days 7, 15, 30, 60, and 90. Sphincter and penile tissue samples were evaluated histologically on days 7 (N = 10) and 30 (N = 10) to detect apoptosis (TUNEL assays) and fibrosis (Trichrome Masson staining). Main Outcome Measures. To assess EF, we measured systemic and penile blood flow using penile laser Doppler and penile rigidity using a durometer before and after apomorphine injection. USF was assessed based on the retrograde leak point pressure (LPPr). Results. Apomorphine increased baseline Doppler flow by 180% (95% confidence interval, 156-202%) and penile hardness from 3.49 ± 0.5 to 7.16 ± 0.82 Shore A units but did not change systemic arterial flow. Mean LPPr was 76.8 ± 6.18 mm Hg at baseline and decreased by 50% after injury, with no response to apomorphine on day 7. EF and USF impairments persisted up to 90 days post injury. Histology showed penile apoptosis on day 7 and extensive urethral sphincter and penile fibrosis on day 30. Our data did not allow us to determine whether the impairment in erectile response to apomorphine preponderantly reflected arterial penile insufficiency or veno-occlusive dysfunction. Conclusion. Electrocautery of the striated urethral sphincter caused severe and lasting impairment of EF and USF that could be monitored repeatedly using minimally invasive methods. This new animal model may hold potential for developing new treatments designed to correct post-RP impairments. Khodari M, Souktani R, Le Coz O, Bedretdinova D, Figeac F, Acquistapace A, Lesault PF, Cognet J, Rodriguez AM, and Yiou R. Monitoring of erectile and urethral sphincter dysfunctions in a rat model mimicking radical prostatectomy damage. J Sex Med 2012;9:2827-2837

EAU Guidelines on Assessment and Nonsurgical Management of Urinary Incontinence

CONTEXT The European Association of Urology guidelines on urinary incontinence (UI) have been updated in cyclical fashion with successive major chapters being revised each year. The sections on assessment, diagnosis, and nonsurgical treatment have been updated as of mid-2016. OBJECTIVE We present a condensed version of the full guideline on assessment and nonsurgical management of UI, with the aim of improving accessibility and increasing their dissemination. EVIDENCE ACQUISITION Our literature search was updated from the previous cut-off of July 2010 up to April 2016. Evidence synthesis was carried out by a pragmatic review of current systematic reviews and any newer subsequent high-quality studies, based on Population, Interevention, Comparator, and Outcome questions. Appraisal was conducted by an international panel of experts, working on a strictly nonprofit and voluntary basis, to develop concise evidence statements and action-based recommendations using modified Oxford and GRADE criteria. EVIDENCE SYNTHESIS The guidelines include algorithms that summarise the suggested pathway for standard, uncomplicated patients with UI and are more useable in daily practice. The full version of the guideline is available at http://uroweb.org/guideline/urinary-incontinence/. CONCLUSIONS These updated guidelines provide an evidence-based summary of the assessment and nonsurgical management of UI, together with a clear clinical algorithm and action-based recommendations. Although these guidelines are applicable to a standard patient, it must be remembered that therapy should always be tailored to individual patients' needs and circumstances. PATIENT SUMMARY Urinary incontinence is a very common condition which negatively impacts patient's quality of life. Several types of incontinence exist and since the treatments will vary, it is important that the diagnostic evaluation establishes which type is present. The diagnosis should also identify patients who need rapid referral to an appropriate specialist. These guidelines aim to provide sensible and practical evidence-based guidance on the clinical problem of urinary incontinence