The aim of this study is to determine whether vitamin D status is associated with incident urinary incontinence (UI) among community-dwelling older adults. The University of Alabama at Birmingham Study of Aging is a prospective cohort study of community-dwelling Medicare enrollees. Standardized assessment of UI was conducted using the validated Incontinence Severity Index. The analysis of 25-hydroxyvitamin D [25(OH)D] levels was performed on stored baseline sera. UI was assessed every 6–12 months for up to 42 months. The analyses included multivariable logistic regression and Cox proportional hazard models. Of 350 participants (175 male, 147 black, mean age 73.6±5.8), 54% (189/350) were vitamin D deficient (25(OH)D <20 ng/ml) and 25% (87/350) were vitamin D insufficient (25(OH)D: 20 ng/ml to <30 ng/ml). Among the 187 subjects with no UI at baseline, 57% (107/187) were vitamin D deficient and 24% (45/187) were vitamin D insufficient. A total of 175 of the 187 subjects had follow-up evaluation for incident UI over 42 months, and incident UI occurred in 37% (65/175). After adjustment, cumulative incident UI at 42 months was associated with baseline vitamin D insufficiency (P=0.03) and demonstrated a trend association with deficiency (P=0.07). There was no association between baseline vitamin D status and the time to incident UI. These preliminary results support an association between vitamin D and incident UI in community-dwelling older adults. Future studies may target specific at-risk groups, such as men with BPH or women with pelvic floor disorders for evaluation of the impact of vitamin D supplementation on urinary symptoms.

Objective: To assess the feasibility and efficacy of exercise-based behavioral therapy to treat urinary incontinence (UI) in older adults with Parkinson disease (PD). Methods: Participants with PD ≥50 years with ≥4 UI episodes on a 7-day bladder diary were recruited from movement disorders clinics. In 5 visits over 8 weeks, participants learned pelvic floor muscle exercises using computer-assisted EMG biofeedback, and bladder control strategies including urge suppression. Bladder diaries were used to reinforce techniques and monitor the primary outcome of UI frequency. Secondary outcomes included additional reporting of lower urinary tract symptoms, symptom bother, and quality of life (QOL) using the International Consultation on Incontinence Questionnaire for overactive bladder (ICIQ-OAB). Results: Twenty participants were enrolled (90% male, age 66.5 ± 6.2 [mean ± SD], with PD for 6.9 ± 5.4 years) and 17 completed the study. The median (interquartile range) weekly frequency of baseline UI episodes was 9 (4–11) and following intervention was 1 (0–3), representing an 83.3% reduction (45.5–100.0, p = 0.0001). QOL scores on the ICIQ-OAB improved from 71.1 ± 23.9 to 54.7 ± 15.4 (p = 0.002). Conclusions: In this uncontrolled pilot study of an exercise-based, biofeedback-assisted behavioral intervention, older participants with PD demonstrated statistically significant and clinically meaningful reductions in frequency of UI and improvement in QOL. Randomized controlled trials to assess behavioral therapies for UI in patients with PD are warranted. Classification of evidence: This study provides Class IV evidence that exercise-based, biofeedback-assisted behavioral intervention can reduce UI frequency in patients >50 years old with PD.

OBJECTIVE:The aim of this study was to examine the association of nocturia with incident falls in a population-based sample of community-dwelling elderly persons. METHODS:The University of Alabama at Birmingham Study of Aging is a prospective cohort study of 1000 community-dwelling older adults in the USA designed to examine factors associated with impaired mobility. Subjects were recruited from a stratified, random sample of Medicare beneficiaries to include equal numbers of black women, black men, white women and white men. Nocturia was assessed at baseline and falls were assessed at baseline and every 6 months for a total of 36 months of follow-up. RESULTS:A total of 692 individuals (mean age 74.5 +/- 6.2, 48% female, 52% black) did not fall in the 12 months prior to baseline. Of these 692, 214 (30.9%) reported falling at least once during the subsequent 3 years. In unadjusted analysis, three or more nightly episodes of nocturia were associated with an incident fall [RR = 1.27, 95% CI (1.01-1.60)]. After multivariable logistic regression, three or more episodes of nocturia were associated with an increased risk of falling [RR = 1.28, (1.02-1.59)]. DISCUSSION:In a racially diverse, community-based sample of older men and women who had not fallen in the previous year, nocturia three or more times a night was associated in multivariable analysis with a 28% increased risk of an incident fall within 3 years. While this study has several advantages over previous reports (longitudinal follow-up, performance-based measures of function, population-based sampling), causality cannot be ascertained. Further research is needed to ascertain the impact of treatments to reduce nocturia as part of a multi-component programme to reduce fall risk.

BACKGROUND Many surgical procedures are available for women with urinary stress incontinence, yet few randomized clinical trials have been conducted to provide a basis for treatment recommendations. METHODS We performed a multicenter, randomized clinical trial comparing two procedures--the pubovaginal sling, using autologous rectus fascia, and the Burch colposuspension--among women with stress incontinence. Women were eligible for the study if they had predominant symptoms associated with the condition, a positive stress test, and urethral hypermobility. The primary outcomes were success in terms of overall urinary-incontinence measures, which required a negative pad test, no urinary incontinence (as recorded in a 3-day diary), a negative cough and Valsalva stress test, no self-reported symptoms, and no retreatment for the condition, and success in terms of measures of stress incontinence specifically, which required only the latter three criteria. We also assessed postoperative urge incontinence, voiding dysfunction, and adverse events. RESULTS A total of 655 women were randomly assigned to study groups: 326 to undergo the sling procedure and 329 to undergo the Burch procedure; 520 women (79%) completed the outcome assessment. At 24 months, success rates were higher for women who underwent the sling procedure than for those who underwent the Burch procedure, for both the overall category of success (47% vs. 38%, P=0.01) and the category specific to stress incontinence (66% vs. 49%, P<0.001). However, more women who underwent the sling procedure had urinary tract infections, difficulty voiding, and postoperative urge incontinence. CONCLUSIONS The autologous fascial sling results in a higher rate of successful treatment of stress incontinence but also greater morbidity than the Burch colposuspension. (ClinicalTrials.gov number, NCT00064662 [ClinicalTrials.gov] .).

Burgio, K L.; Richter, H E.; Clements, R H.; Goode, P S.; Varner, R; Redden, D T. Author Information

OBJECTIVE: The objective of this study was to determine the incidence and predictors of urinary incontinence (UI) over 3 years in a population-based survey of older community-dwelling women. METHODS: This study consisted of a prospective, observational cohort study of women age ≥65 years representing a stratified, random sample of Alabama Medicare beneficiaries. Participants underwent baseline in-home assessments of sociodemographics, medical conditions (verified by medication history, MD questionnaires, or review of hospital discharge records), and self-reported health and functional status. Physical performance testing was also conducted. Data from annual follow-up telephone interviews were used to ascertain incident UI. Urinary incontinence was defined as an affirmative response to “In the past 6 months, have you leaked even a very small amount of urine?” reported as occurring at least once a month. For categorical variables, chi-squared analyses were used to test for associations between baseline characteristics and new UI within 3 years of enrollment. Logistic regression models were developed to examine the relationship between continuous predictors and new UI within 3 years of enrollment. All analyses were performed using SAS. RESULTS: Participants (N=499) had a mean age of 75.7 years (standard deviation = 7.0; range, 65–106); 50% were black and 50% were rural. Prevalence of UI at baseline was 41.9%. For women continent at baseline, 42 of 273 (15.4%) developed UI at 1 year, 27 of 212 (12.7%) at 2 years, and 15 of 169 (8.9%) at 3 years. The overall incidence of new UI over 3 years was 30.2% (84 of 278). Predictors of new UI included baseline history of stroke (P=0.004), fecal incontinence (P=0.007), past or current estrogen use (P=0.013), longer time to stand up from a chair 5 times (P=0.015), lower physical and mental scores on the SF-12 (P=0.022 and 0.047), and higher Geriatric Depression Score (0.003). Not predictive of new UI were age, race, body mass index, income, parity, total comorbidity score, diabetes, falls, and Mini Mental State Exam score. CONCLUSION: Prevalence of UI among community-dwelling older women was high at baseline and an additional 30% of women reported incident incontinence over 3 years of follow up. Estrogen use, history of stroke, depression, and lower physical performance predicted new incontinence.

OBJECTIVES: To examine changes in nocturia from a multicomponent behavioral training program or drug therapy in older women with urge or mixed (urge-predominant) urinary incontinence.DESIGN: A secondary analysis of data from a prospective, randomized clinical trial.SETTING: Parent trial was an outpatient research protocol in Alabama.PARTICIPANTS: One hundred ninety-seven women (aged 55-92) with incontinence and urodynamic evidence of bladder dysfunction. At baseline, 131 women (66% of participants) had nocturia.INTERVENTION: In the parent study, participants received behavioral training, including four sessions of biofeedback-assisted pelvic floor muscle exercises, drug treatment (oxybutynin IR titrated from 2.5 mg per day to 5.0 mg three times a day), or placebo.MEASUREMENTS: Participant-completed bladder diaries were used to calculate changes in nocturia.RESULTS: Behavioral training reduced nocturia by a median 0.50 episodes per night and was significantly more effective than drug treatment (median reduction=0.30 episodes; P=.02) and placebo (median reduction=0.00 episodes; P <.001). Also, drug treatment was more effective than control (P=.007).CONCLUSION: Both behavioral training and drug treatment reduced nocturia more than placebo, but behavioral training was the most effective.