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      Hidden prevalence of lower urinary tract symptoms in healthy nulligravid young women

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          Abstract

          Introduction and hypothesis

          Lower urinary tract symptoms (LUTS) and urinary incontinence (UI) may have a major impact on quality of life. However, not all individuals with urological complaints seek medical advice. The aim of this study was to investigate the prevalence of LUTS in young otherwise healthy nulligravid women and the accompanying burden.

          Methods

          A total of 159 young presumably healthy female medical students aged 18–30 years were recruited at their university. All completed the International Consultation on Incontinence Modular Questionnaire for Female Lower Urinary Tract Symptoms. The prevalence of LUTS and the accompanying burden were measured. Correlations between symptoms and bother were analysed using Spearman’s rho.

          Results

          LUTS was found in 94.3 % of the women, urgency at least sometimes in 14.5 %, and hesitancy in 14.5 %. Nocturia once a night was reported by 18.2 % of the women; none reported nocturia of more than twice a night. Involuntarily loss of urine was reported by 20.1 % of the women but none reported this occurring more than twice a week. The median value of all bother scores was 0; the highest bother score was for urgency. For all questions a positive correlation was found between symptoms and bother; a strong correlation was found for bladder pain, urgency UI, stress UI and overall UI.

          Conclusions

          In a presumably healthy population of young nulligravid women the prevalence of LUTS and UI was high, but with relatively low bother.

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          The Bristol Female Lower Urinary Tract Symptoms questionnaire: development and psychometric testing.

          Robert J Donovan, Paul Brookes, Scott Jackson … (1996)
          To develop a questionnaire that is sensitive to changes in the symptomatology of the female lower urinary tract, particularly urinary incontinence, providing an instrument that can characterize symptom severity, impact on quality of life and evaluate treatment outcome. Items covering as wide a range of urinary symptoms as possible were devised after consultation with clinicians and a health scientist, a literature review and discussion with patients. Additional items assessed the degree of 'bother' that symptoms were causing. Eighty-five women with clinical symptoms attending for urodynamic assessment and 20 women with none were asked to self-complete the questionnaire. The instrument's validity was assessed by interviewing patients and measuring levels of missing data, comparing symptom scores between clinical and non-clinical populations and comparison with frequency/volume charts and data from pad tests. The instrument's reliability was assessed by measuring both internal consistency and stability, using a 2-week test-retest analysis. The questionnaire was completed by the patients with a mean of only 2% of items missing; most questions were easily understood. Construct validity was good, with the instrument easily differentiating clinical and non-clinical populations. Criterion validity, as tested against frequency/volume charts and pad-test data, was acceptable, with Kappa coefficients of 0.29-0.79 for frequency/volume data and Spearman rank correlations of 0.50-0.97 and 0.31-0.67 for frequency/volume and pad-test data, respectively. The reliability of the instrument was good; a Cronbach's alpha of 0.78 indicated that the symptom questions had high internal consistency, while stability was excellent, with 78% of symptoms and problems answered identically on two occasions, and Spearman rank correlations of 0.86 and 0.90, respectively. The instrument has good psychometric validity and reliability. The stability demonstrated at baseline and the ability to differentiate clearly between community and clinical populations suggest that it should be ideal for measuring changes following therapeutic intervention. The addition of life-impact items and a 'bother' factor may provide the opportunity to identify those women who wish treatment for their symptoms; this dimension requires further exploration.
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            The impact on health-related quality of life of stress, urge and mixed urinary incontinence.

            Elaine C. Thompson, E Versi, K Coyne … (2003)
            To examine the impact of each type of urinary incontinence (stress, urge, and mixed) on health-related quality of life (HRQL). The USA National Overactive Bladder Evaluation (NOBLE) programme of prevalence was used to identify respondents with incontinence based upon telephone survey responses. A nested case-control study was then conducted on respondents with symptoms of an overactive bladder (OAB), and on age and gender-matched controls; this consisted of the respondents completing a series of questionnaires, including the OAB-q (an HRQL scale for OAB), the Medical Outcomes Study (MOS) Short-Form-36 (SF-36), the MOS Sleep Scale, and the Center for Epidemiological Studies - Depression (CES-D) scale. Respondents were categorized into subgroups according to the primary cause of urine loss, i.e. sudden/uncomfortable urge to urinate (urge, UI), physical pressure (stress, SI), or both (mixed, MI). Descriptive analyses, t-tests and analysis of variance with post hoc comparisons were used. Of the 919 participants in the nested case-control study, 171 reported incontinence, i.e. UI (69), SI (62) and MI (40). Among this cohort, 82.5% were female, 85.4% were Caucasian and the population had a mean age of 55.9 years. All OAB-q subscale scores were significantly (P < 0.01) worse among those with MI than with SI. Respondents with UI reported significantly higher levels of symptom bother and lower sleep scores (both P < 0.001) than those with SI. There were no differences in HRQL between the MI and UI groups. Voiding frequency and nocturia episodes did not differ among the groups but compared with the SI group, both UI and MI groups reported significantly higher ratings of urinary urge intensity (P < 0.001) and rated their need for medical care significantly higher (P < 0.01). The MI group reported more incontinence episodes (P = 0.02) than the SI group. Compared with SI, respondents with UI and MI reported not only significantly greater ratings of urinary urge intensity and more incontinence episodes, but also significantly worse HRQL. These results are consistent with previous findings which indicated a greater impact on HRQL for the urge component of MI than for the stress component.
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              Diagnostic classification of female urinary incontinence: an epidemiological survey corrected for validity.

              H Sandvik (1995)
              Diagnostic questions about stress and urge incontinence were validated against a final diagnosis made by a gynecologist after urodynamic evaluation. Thereafter, an epidemiological survey was performed, using similar questions, and correcting the answers for lack of validity. Included were 250 incontinent women at the out-patient clinic and 535 women who reported incontinence in the epidemiological survey. The sensitivity for stress incontinence was 0.66 (95% confidence interval +/- 0.08), specificity 0.88 (+/- 0.06). The corresponding values for urge incontinence were 0.56 (+/- 0.15) and 0.96 (+/- 0.03), and for mixed incontinence 0.84 (+/- 0.10) and 0.66 (+/- 0.07). Using these indices of validity as corrective measures for the diagnostic distribution reported in the epidemiological survey, the percentage of stress incontinence increased from 51 to 77%, while mixed incontinence was reduced from 39 to 11%. Pure urge incontinence increased from 10 to 12%. Mixed incontinence will be overreported in epidemiological surveys. Correction for validity indicates that a larger majority than hitherto reported may have pure stress incontinence.
              Article 0 comments Cited 24 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Hendrikje M. K. van Breda: +31 24 3613735 , Jetske.vanBreda@radboudumc.nl
                J. L. H. Ruud Bosch: +31 88 7558079
                Laetitia M. O. de Kort: +31 88 7558079
                Journal
                Journal ID (nlm-ta): Int Urogynecol J
                Journal ID (iso-abbrev): Int Urogynecol J
                Title: International Urogynecology Journal
                Publisher: Springer London (London )
                ISSN (Print): 0937-3462
                ISSN (Electronic): 1433-3023
                Publication date (Electronic): 18 June 2015
                Publication date PMC-release: 18 June 2015
                Publication date (Print): 2015
                Volume: 26
                Issue: 11
                Pages: 1637-1643
                Affiliations
                [ ]Department of Urology (610), Radboud University Medical Center, P.O. Box 9101 (610), NL-6500 HB Nijmegen, The Netherlands
                [ ]Department of Urology (HP C 04.236), University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
                Article
                Publisher ID: 2754
                DOI: 10.1007/s00192-015-2754-1
                PMC ID: 4611019
                PubMed ID: 26085465
                SO-VID: fb031e1e-9a29-4f07-ab8d-82e9e44ff431
                Copyright © © The Author(s) 2015
                License:

                Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

                History
                Date received : 24 December 2014
                Date accepted : 26 May 2015
                Categories
                Subject: Original Article
                Custom metadata
                issue-copyright-statement © The International Urogynecological Association 2015

                ScienceOpen disciplines: Obstetrics & Gynecology
                Keywords: lower urinary tract symptoms (luts),nulligravida,prevalence,urinary incontinence,women
                Data availability:
                ScienceOpen disciplines: Obstetrics & Gynecology
                Keywords: lower urinary tract symptoms (luts), nulligravida, prevalence, urinary incontinence, women

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