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AIM: The aim was to estimate the postpartum urinary incontinence (PP UI) impact of precursory UI during pregnancy (PR UI) and delivery performed by cesarean section (CS) vs. vaginal childbirth (VC). METHODS: Among the members of two population samples, in total 8610 women aged 20-59 years, 1232 had their first childbirth and 642 their second childbirth within 13-120 months prior to responding to a questionnaire that included information on PR UI occurrence, mode of delivery and PP UI occurrence. RESULTS: CS was applied in 12.2% of first childbirths, and 87.8% thus delivered vaginally; PR UI during the pregnancy leading to the first childbirth was reported by 15.6%, and a total of 26.3% reported PP UI. An increased PP UI occurrence was reported following VC (28.3% vs. 12.0% in women undergoing CS, p < 0.001) and after PR UI (first childbirth, 66.7% vs. 18.8% in women not reporting PR UI, p < 0.0001). Among cases of PP UI following the first childbirth, 56.1% and 69.5% of cases could be attributed to PR UI and VC, respectively. CONCLUSIONS: The highest PP UI risks were found among women complaining of PR UI, which manifested itself as a crucial, independent precursor of PP UI. Because of the high frequency of VC, more than seven out of 10 cases of UI following the first childbirth, however, seemed to be attributable to VC. The present data did not lend significant support to the assumption that the PP UI risk is also lowered after a subsequent delivery by CS.

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Our aim was to study the association between menstrual cycle characteristics, the use of female hormones and urinary incontinence (UI) in an age-stratified random population sample of 2158 premenopausal women who answered a questionnaire on urinary incontinence. Episodes of UI during 1997 were reported by 18.3% and one or more episodes of UI the preceding year by 3.9%. Based on multiple logistic regression, self-reported UI the day before answering the questionnaire was found to be associated with current hormone use for menstrual disorders (OR 2.7, 95% CI 1.2-6.6), a recent decrease in bleeding duration (OR 2.2, 95% CI 1.3-3.7), being on days 11-15 before the expected end of the menstrual cycle the preceding day (OR 2.6, 95% CI 1.3-5.0), and with general UI risk factors, i.e. vaginal childbirth, childhood enuresis, BMI >/=530 and exposure to abdominal and/or gynecologic surgery. The findings are in accordance with a hypothesis of hormonal variation being a risk indicator of UI in premenopausal women.

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In a population sample, the period prevalence of urinary incontinence (UI) during pregnancy was found to be 19.9% and 24.1% among 352 nulliparous and 290 primiparous women, respectively. The first UI episode ever was experienced by 16.7% and 7.0% during the two last trimesters of the first and second pregnancies, respectively. None of the pregnancy-specific risk factors, such as emesis and birthweight, was significantly associated with UI during pregnancy. Previous UI was a significant risk factor for period prevalent UI during pregnancy, explaining 34% and 83% of pregnancy UI for the nulliparous and the primiparous, respectively. The present data suggest pregnancy UI not to be provoked by the mere onset of pregnancy, but by increasing hormonal concentrations or local tissue changes caused by hormones, whereas there was no support for a theory based on increasing pressure on the bladder caused by the weight of the fetus.

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The aim was to examine the association between pregnancy, vaginal childbirth (VC) and obstetric techniques, and the prevalence of urinary incontinence (UI). A cross-sectional survey enrolled a random population sample of 6240 women aged 20-59 years, who were mailed a self-administered questionnaire on UI and, among other things, experience of VC and obstetric intervention. More than 75% responded. The present analysis includes 4345 women. Multivariate UI prevalence odds ratios were increased in relation to UI during pregnancy, UI following immediately after a VC, and age 30 or more at the second VC. No multivariate association was found in relation to forceps delivery or vacuum extraction delivery, episiotomy or perineal suturing. In conclusions, not only the process of childbirth itself but also processes during pregnancy seem to be strongly associated with prevalent UI. Perineal suturing may be associated with prevalent UI, whereas other obstetric techniques inspected do not seem to be so.

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Tobacco use is an established cause of bladder cancer. The ability to detoxify aromatic amines, which are present in tobacco and are potent bladder carcinogens, is compromised in persons with the N-acetyltransferase 2 slow acetylation polymorphism. The relationship of cigarette smoking with bladder cancer risk therefore has been hypothesized to be stronger among slow acetylators. The few studies to formally explore such a possibility have produced inconsistent results, however. To assess this potential gene-environment interaction in as many bladder cancer studies as possible and to summarize results, we conducted a meta-analysis using data from 16 bladder cancer studies conducted in the general population (n = 1999 cases), Most had been conducted in European countries. Because control subjects were unavailable for a number of these studies, we used a case-series design, which can be used to assess multiplicative gene-environment interaction without inclusion of control subjects. A case-series interaction odds ratio (OR) > 1.0 indicates that the relationship of cigarette smoking and bladder cancer risk is stronger among slow acetylators as compared with rapid acetylators. We observed an interaction between smoking and N-acetyltransferase 2 slow acetylation (OR, 1.3; 95% confidence interval, 1.0-1.6) that was somewhat stronger when analyses were restricted to studies conducted in Europe (OR, 1.5; confidence interval, 1.1-1.9), a pooling that included nearly 80% of the collected data. Using the predominantly male European study population and assuming a 2.5-fold elevation in bladder cancer risk from smoking, we estimated that the population attributable risk percent was 35% for slow acetylators who had ever smoked and 13% for rapid acetylators who had ever smoked. These results suggest that the relationship of smoking and bladder cancer is stronger among slow acetylators than among rapid acetylators.

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The value of the BARD bladder tumour antigen (BTA) test for the diagnosis of bladder tumour was compared to urinary cytology. A total of 60 patients with bladder tumours (Category Ta: 39 patients and Category T1-4: 21 patients) were investigated. Urinary cytology was found to be more sensitive than the BTA test. The overall sensitivity of cytology was 0.63 compared to 0.27 for the BTA test. The sensitivity of both tests improved with increasing tumour severity. For Ta tumours and T1-4 tumours the sensitivity of cytology was 0.46 and 0.95 respectively, and for the BTA test it was 0.13 and 0.53 respectively. We conclude that urinary cytology is superior to the BTA test. The BTA test cannot be recommended either for bladder tumour screening or monitoring for recurrence because of too many false negative results. Because of its high specificity (0.93), a positive BTA test might reduce the number of flexible cystoscopies, and prepare the patient directly for tumour resection.

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OBJECTIVES: This study examined the association between pregnancy, vaginal childbirth and obstetric techniques, and the prevalence of urinary incontinence among adult women aged 20 to 59 years. METHODS: A cross-sectional survey enrolled a random sample of 6240 women aged 20 to 59 years who were mailed a self-administered questionnaire focusing on urinary incontinence and other health variables. More than 75% of the women responded. The present analysis includes 4345 women who were not pregnant and did not experience a vaginal childbirth during 1994. RESULTS: Multivariate prevalence odds ratios showed increases in relation to urinary incontinence during pregnancy, urinary incontinence immediately after a vaginal childbirth, and age of 30 years or more at the second vaginal childbirth. No multivariate associations were found for forceps delivery or vacuum extraction delivery, episiotomy, or perineal suturing. CONCLUSION: Not only the process of childbirth itself but also processes during pregnancy seem to be strongly associated with prevalent urinary incontinence. Perineal suturing may be associated with prevalent urinary incontinence, whereas other obstetric techniques inspected do not seem to be so.

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OBJECTIVE: To investigate the effect of applying a problem assessment versus a pure symptom urinary incontinence (UI) caseness definition in etiologic research. SUBJECTS: A random population sample of 2613 women aged 30-59 years, who responded to a postal questionnaire. MAIN PARAMETERS: One-year period prevalence of the symptom of stress UI; UI assessed by the woman to be a social and/or hygienic problem; childbirth and history of abdominal, gynecological, obstetric or urologic surgery. RESULTS: Among the 388 women (14.8% of the population sample) who reported stress UI, 62.6% considered it a social or hygienic problem, and 21.9% had ever abstained socially because of UI. Applying a problem assessment caseness definition caused under-estimation of the role of childbirth, as compared with analyses including a pure symptom caseness definition. CONCLUSION: The International Continence Society (ICS) incontinence definition presents intrinsic logical problems that invalidates its use in biomedical, if not in sociomedical, research. As definition and medical decision are different concepts, this does not necessarily affect the potential utility of the problem assessment aspect when used in everyday clinical practice as a basis for the decision whether to treat women with UI or not.

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PURPOSE: We compared the effect of 560 mg. estramustine phosphate daily to placebo as a supplement to standard palliative therapy in patients with progressive disease after bilateral orchiectomy as first line therapy for metastatic prostate cancer. MATERIALS AND METHODS: In a double-blind multicenter study 131 patients with progressing metastatic hormone refractory prostate cancer were randomized to receive 280 mg. estramustine phosphate 2 times daily versus placebo. End points were clinical progression and death. Adverse events, decrease in prostate specific antigen (PSA) and subjective response were also assessed. RESULTS: Adverse events were common in both groups but breast tenderness/gynecomastia and diarrhea were more frequent among patients in the estramustine phosphate group. Subjective responses were few (9 of 50 estramustine phosphate and 4 of 57 placebo cases, p = 0.15). Median observation time for survival was 43 months and 124 patients died. Median time to subjective progression and median overall survival did not differ significantly between the 2 groups at 4.6 and 9.4 months in the estramustine phosphate group versus 5.0 and 6.1 months in the placebo group. Of 61 patients in the estramustine phosphate group 29 achieved a reduction in PSA of more than 25% at 1 month of followup compared to only 3 of 68 receiving placebo. A decrease in PSA after 1 month correlated significantly with survival. CONCLUSIONS: Although this study did not prove estramustine phosphate to be superior to placebo in terms of protocol end points, it generates the hypothesis that prolonged survival may be achieved with estramustine phosphate treatment in a subgroup of patients and that this may be predicted by a decrease in PSA after 1 month of therapy.

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The aim was to study the possible role of obesity in adult female urinary incontinence (UI) etiology. A random population sample of 3114 women aged 30-59 were sent a postal questionnaire concerning urinary incontinence and, among other things, body weight and height. The overall response rate was 85%, and the present analysis comprises 2589 women who gave information about their body weight and height. The period prevalence of all, stress, urge, and mixed stress and urge urinary incontinence (UI) was 17%, 15%, 9% and 7%, respectively. The mean body mass index (BMI) was 22.7 kg/m2. Irrespective of other risk indicators, BMI was positively associated with UI prevalence (OR 1.07 per BMI unit, p < 0.0001). BMI interacted with childbirth in predicting stress UI prevalence, with cystitis in predicting urge UI, and with both in predicting mixed UI. Stress UI turned out to be the UI type most closely associated with BMI.

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In the staging of locally advanced bladder cancer and localized prostate cancer 22 consecutive patients underwent open pelvic lymphadenectomy and 9 consecutive patients underwent laparoscopic pelvic lymphadenectomy. The two operations were compared with number of lymph nodes removed, operative time, hospital stay, and postoperative complications. By the open and laparoscopic surgery in average 5.7 and 6.6 lymph nodes were removed, respectively. The laparoscopic procedure was more time-consuming, however, the hospital stay and postoperative complications were minor compared with the open operation. The laparoscopic pelvic lymphadenectomy as a staging procedure for carcinoma of the urinary bladder or localized prostate cancer is minimally invasive and a good alternative to open lymph node dissection.

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A questionnaire on the follow-up regimens for Ta grade I-III bladder tumors in Denmark was mailed to 54 urological and surgical departments. Reply rate was 87%. Most patients were followed in out-patient clinics. Transabdominal ultrasound of the bladder was used by 9% of the departments while 36% of the departments used urinary cytology. Seventy-seven percent of the departments routinely took selected site biopsies at the primary tumor resection while only 14 departments (30%) used selected site biopsies during the follow-up. Forty percent of the departments considered carcinoma in-situ and Ta grade III malignant and Ta grade I and II benign while 6% regarded all four categories as malignant. A guideline for characterization and surveillance of bladder tumor patients is needed.

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In order to reevaluate the indications for an acute excretory urography (IPV) after blunt renal trauma, with special emphasis on the degree of haematuria, the medical records of 114 patients admitted to The Department of Urology, Odense University Hospital during a 10 year period were reviewed. Fourteen cases of major renal damage were revealed. Thirteen of these patients had macroscopic haematuria. Three of the thirteen patients were in shock and required an acute operation in order to stabilize their blood pressure. In one case, a thirteen year old girl had a major renal lesion which was diagnosed by acute IVP before examination of the urine. The present data support other reports in the literature stating that radiographic imaging is not necessary in the adult sustaining blunt renal trauma with microscopic haematuria and no shock. However, we find good reason for radiographic evaluation of all children after a blunt renal trauma, independent of the degree of haematuria.

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In the period 1986-1990 a total of 69 patients with advanced prostate cancer and urinary retention underwent orchiectomy followed by removal of the indwelling catheter during the 3 month/postoperative period. The mean follow-up time was 32 months. Regarding urination after catheter removal the success-rate was 62% (43/69) and 84% of these patients were satisfied with the procedure. For these 43 patients the median time without the catheter was 21.5 months. Eleven patients with success developed a new attack of urinary retention. Bladder catheter removal during 3 months after orchiectomy for patients with advanced prostate cancer and urinary retention is recommended.

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The results of ileocystoplasty in nine patients with interstitial cystitis were evaluated. In addition to the information obtained from the hospital records, all patients answered a postal questionnaire. No serious complications occurred. Mean follow-up was 95 months (75-125 months). Seven patients were continent, of whom three were practising clean intermittent self-catheterization (CIS). One patient remained stress and urge incontinent in spite of CIS. After an uncomplicated operation one patient died seven years later from unknown causes. Six patients were very satisfied and two fairly satisfied with the outcome of the operation. All would accept a new operation if necessary.

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A cross-sectional random population sample of women 30 to 59 years old was sent a questionnaire on urinary incontinence and, among other things, childhood bedwetting. Among 2,613 responders 17.0% reported prevalent urinary incontinence (14.7% stress provoked, 8.3% associated with urge, 6.8% stress and urge overlap, 2.2% occurring especially during sleep and 3.9% occurring especially when anxious), and 6.5% reported childhood bedwetting after age 5 years and 3.3% after age 10 years. Childhood bedwetting was associated with prevalent urge urinary incontinence (p < 0.01) and incontinence occurring during sleep (p < 0.0001) but was less marked with urinary incontinence occurring in situations of anxiety (p < 0.025). It is concluded that some individuals suffer a long-lasting disturbance of the balance between micturition and sleep processes.

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In a cross-sectional study, 85% of 3114 women responded to a questionnaire on urinary incontinence and a history of abdominal, gynaecological and urological surgery. The prevalence of urinary incontinence was 17%; 63% had undergone surgery, mainly gynaecological, and almost one-third of the respondents had had more than one operation. Bivariate and multivariate analysis showed stress urinary incontinence to be associated with previous exposure to surgery.

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The results of clam ileocystoplasty in 32 patients were evaluated. Nineteen patients had a neuropathic (group N) and 13 a nonneuropathic disease (group NN). Mean follow-up was 75 months; 62 months for group N and 95 months for group NN. Mean age was 38 years. Postoperative complications and some quality-of-life parameters including continence, and the need for clean intermittent self-catheterization and an artificial sphincter were assessed. The mean pre-/postoperative bladder volumes were for group N and NN 173/364 ml and 171/246 ml, respectively. Eighty percent of the patient were satisfied with the operation and would undergo a new operation if necessary. The remainder had some expectations that were unfulfilled.

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The aim of the present investigation was to study the possible role of obesity in the etiology of adult female urinary incontinence (UI). A random population sample of 3,114 women aged 30-59 years were mailed a questionnaire concerning UI and, among other things, body weight and height. The overall rate of response was 85%, and the present analysis comprises 2,589 women who supplied information about their body weight and height. The period prevalence of all UI, stress UI, urge UI, and mixed stress and urge UI was 17%, 15%, 9%, and 7%, respectively. The mean body mass index (BMI) was 22.7 kg/m2. Irrespective of other risk indicators, BMI was positively associated with UI prevalence (OR, 1.07/BMI unit; P < 0.0001). BMI interacted with childbirth in predicting stress UI prevalence, with cystitis in predicting urge UI, and with both in predicting mixed UI. Stress UI proved to be the UI type most closely associated with BMI.

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