PREVALENCE, INCIDENCE AND OBSTETRIC CARE IMPACTFOR WOMEN WITH URINARY INCONTINENCE IN EUROPE: ASYSTEMATIC AND QUALITATIVE REVIEW OF THE LITERATURE

Introduction and Aim of the Study: Urinary Incontinence (UI) is a prevalent, bothersome and costly condition, affecting primarily women. UI is not a lethal condition, but it deeply affects a woman’s quality of life. The issue of UI has been well documented and there are national and international networks focusing on the condition. However there is a lack of systematic, reliable and consistent data, particularly with regards to certain sections of the female population. The aimof this study was to carry out a systematic synthesis of the published evidence about prevalence, incidence, obstetric care and impact of economical and human burden for women with UI in Europe. Materials and Methods: Epidemiologic and interventional studies were sought from MEDLINE via PubMed to identify articles published in English, French, Spanish, German and Italian between 2000 and September 30, 2009. Prevalence and incidence of female UI in the European general population and among pregnant and post-partum women were abstracted into the developed standardized form in order to answer the following three questions: 1. What are the incidence and prevalence ofUrinary Incontinence inWomen in Europe and its specific subtypes? 1a. How are incidence and prevalence influenced by pregnancy and childbirth? 2. How do obstetric factors impact on prevalence and incidence of UI in women after delivery in Europe? 3. How does Female Urinary Incontinence impact on economic and human burden in Europe? Patient outcomes after different obstetric interventionswere compared fromrandomized controlled clinical trials (RCTs) and observational studies. The impact of female UI on quality of Life and economical aspects were abstracted from previous systematic reviews and meta-analyses, controlled clinical trials and observational studies. Results: One hundred thirty three publications were eligible for the review. The prevalence of UI of any type in noninstitutionalised women in Europe ranged from 14.10% up to 68.8%. The prevalence was higher with increasing age: any degree of UI was reported by 6–30% of women aged 18–24 up to 50–67% of 90-year-old ladies. The annual incidence of female UI in Europe ranged from 2.9% up to 8.3%. Significant risk factors for UI in pregnancy were maternal age 35 years (HR 2.1; 95% CI 1.0–2.8), maternal initial body max index (HR 1.3; 95%CI 1.1–1.6), a family history positive for UI (HR 1.7; 95% CI 1.3–2.2), and parity (OR 2.0; 95% CI 2.0–2.2). The prevalence rates of UI ‘‘at term’’ pregnancy in Europe ranged from 26% up to 40.2%, with a remission rate 3months after childbirth up to 86.4%. The prevalence rates of post-partumUI at 3months after childbirth ranged from 2.2% up to 15%. UI during pregnancy represented a significant risk factor for the persistence of UI after delivery (OR 3.71; 95% CI 1.95–7.06). The major obstetric risk factor was the mode of delivery. The caesarean section seemed to be more protective than vaginal delivery, but this advantage disappeared after the second caesarean delivery (OR 0.47; 95% CI 0.04–5.69). Five RCTs focused on the impact of antenatal Pelvic Floor Muscle Training (PFMT) on the improvement of the continence status in women after childbirth. Antenatal PFMT could be helpful in the post-partum UI prevention in primiparous women without UI during pregnancy. Evidence from population-based studies showed a great impact of UI (mainly urge UI/Overactive bladder wet and mixed UI) in several health related quality of life (HR-QoL) domains such as anxiety and depression, sexual function impairment, limitation of physical activity, loss of independent living in elderly and overall impairment of QoL. Several studies examined the economic burden of UI, highlighting the significant impact of this condition on patients and society. Interpretation of Results: A wide variation in the estimates of the prevalence and incidence of female UI in Europewas found. The age represents a significant risk factors. Although an under-representation of elderly women, the highest rates of prevalence were shown in this age group. But these findings came from a few studies that formally tested whether the estimates of prevalence in women of different ages were different from each other statistically. The methods used to collect data, as well as the way in which UI was identified, contributed to the wide variability in findings. Studies of incidence highlighted that UI often may be transient. Among the many methods proposed to prevent postpartum UI, episiotomy and PFMT were investigated. The results are disappointing or limited. Conclusions: There is still an evident heterogeneity in UI definition, outcome measures, survey methods, validation criteria that make impossible to compare data and to report conclusive findings. There is a clear need to perform observational and interventional studies in Europe in order to better answer the above mentioned questions using homogeneous and standardised criteria mainly for sampling and outcome measurements.