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Clinical epidemiological insights into urinary incontinence

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Abstract

Introduction and hypothesis

Urinary incontinence (UI) is very common and heterogeneous among women with limited knowledge of progression or prognosis. Evidence based on clinical epidemiology can help to better understand the natural history of UI.

Methods

We examine the challenges of UI definition and its subtypes, its impact on quality of life and health-seeking behavior. We review the proposed pathophysiology of UI subtypes and known risk factors as they relate to our current knowledge of the disease state. Finally, we emphasize the role of epidemiology in the process of acquiring new insight, improving knowledge, and translating this information into clinical practice.

Results

Stress UI is most common overall, but mixed UI is most prevalent in older women. The three UI subtypes have some common risk factors, and others that are unique, but there remains a significant gap in our understanding of how they develop. Although the pathophysiology of stress UI is somewhat understood, urgency UI remains mostly idiopathic, whereas mixed UI is the least studied and most complex subtype. Moreover, there exists limited information on the progression of symptoms over time, and disproportionate UI health-seeking behavior. We identify areas of exploration (e.g., epigenetics, urinary microbiome), and offer new insights into a better understanding of the relationship among the UI subtypes and to develop an integrated construct of UI natural history.

Conclusion

Future epidemiological strategies using longitudinal study designs could play a pivotal role in better elucidating the controversies in UI natural history and the pathophysiology of its subtypes leading to improved clinical care.

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References

  1. Gordis L. The natural history of disease: ways of expressing prognosis. In: Gordis L, editor. Epidemiology. Philadelphia: Elsevier/Saunders; 2004. p. 95–114.

    Google Scholar 

  2. Hulley SB, Newman TB, Cummings SR. Getting started: the anatomy and physiology of clinical research. In: Hulley SB, Cumming SR, Browner WS, Grady D, Hearst N, Newman TB, editors. Designing clinical research. Philadelphia: Lippincott Williams and Wilkins; 2001, p. 3–16.

    Google Scholar 

  3. Bates P, Bradley WE, Glen E, Griffiths D, Melchior H, Rowan D, et al. The standardization of terminology of lower urinary tract function. J Urol. 1979;121:551–4.

    CAS  PubMed  Google Scholar 

  4. Haylen BT, de Ridder D, Freeman RM, Swift SE, Berghmans B, Lee J, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Int Urogynecol J. 2010;21:5–26.

    Article  PubMed  Google Scholar 

  5. Minassian VA, Drutz HP, Al-Badr A. Urinary incontinence as a worldwide problem. Int J Gynaecol Obstet. 2003;82:327–38.

    Article  CAS  PubMed  Google Scholar 

  6. Komesu YM, Schrader RM, Ketai LH, Rogers RG, Dunivan GC. Epidemiology of mixed, stress, and urgency urinary incontinence in middle-aged/older women: the importance of incontinence history. Int Urogynecol J. 2016;27:763–72.

    Article  PubMed  Google Scholar 

  7. Kammerer-Doak D, Rizk DE, Sorinola O, Agur W, Ismail S, Bazi T. Mixed urinary incontinence: International Urogynecological Association research and development committee opinion. Int Urogynecol J. 2014;25:1303–12.

    Article  PubMed  Google Scholar 

  8. Molinuevo B, Batista-Miranda JE. Under the tip of the iceberg: psychological factors in incontinence. Neurourol Urodyn. 2012;31:669–71.

    Article  PubMed  Google Scholar 

  9. Nygaard I, Turvey C, Burns TL, Crischilles E, Wallace R. Urinary incontinence and depression in middle-aged United States women. Obstet Gynecol. 2003;101:149–56.

    PubMed  Google Scholar 

  10. Felde G, Bjelland I, Hunskaar S. Anxiety and depression associated with incontinence in middle-aged women: a large Norwegian cross-sectional study. Int Urogynecol J. 2012;23:299–306.

    Article  PubMed  Google Scholar 

  11. Stewart WF, Van Rooyen JB, Cundiff GW, Abrams P, Herzog AR, Corey R, et al. Prevalence and burden of overactive bladder in the United States. World J Urol. 2003;20:327–36.

    CAS  PubMed  Google Scholar 

  12. Thom DH, Haan MN, Van Den Eeden SK. Medically recognized urinary incontinence and risks of hospitalization, nursing home admission and mortality. Age Ageing. 1997;26:367–74.

    Article  CAS  PubMed  Google Scholar 

  13. Hu TW, Wagner TH, Bentkover JD, Leblanc K, Zhou SZ, Hunt T. Costs of urinary incontinence and overactive bladder in the United States: a comparative study. Urology. 2004;63:461–5.

    Article  PubMed  Google Scholar 

  14. Grodstein F, Fretts R, Lifford K, Resnick N, Curhan G. Association of age, race, and obstetric history with urinary symptoms among women in the Nurses’ Health Study. Am J Obstet Gynecol. 2003;189:428–34.

    Article  PubMed  Google Scholar 

  15. Wu JM, Hundley AF, Fulton RG, Myers ER. Forecasting the prevalence of pelvic floor disorders in U.S. Women: 2010 to 2050. Obstet Gynecol. 2009;114:1278–83.

    Article  PubMed  Google Scholar 

  16. Herzog AR, Fultz NH. Prevalence and incidence of urinary incontinence in community-dwelling populations. J Am Geriatr Soc. 1990;38:273–81.

    Article  CAS  PubMed  Google Scholar 

  17. Thom D. Variation in estimates of urinary incontinence prevalence in the community: effects of differences in definition, population characteristics, and study type. J Am Geriatr Soc. 1998;46:473–80.

    Article  CAS  PubMed  Google Scholar 

  18. Hunskaar S, Burgio K, Diokno A, Herzog AR, Hjalmas K, Lapitan MC. Epidemiology and natural history of urinary incontinence in women. Urology. 2003;62:16–23.

    Article  PubMed  Google Scholar 

  19. Hannestad YS, Rortveit G, Sandvik H, Hunskaar S, Norwegian EPINCONT study. Epidemiology of incontinence in the County of Nord-Trondelag. A community-based epidemiological survey of female urinary incontinence: the Norwegian EPINCONT study. Epidemiology of Incontinence in the County of Nord-Trondelag. J Clin Epidemiol. 2000;53:1150–7.

    Article  CAS  PubMed  Google Scholar 

  20. Melville JL, Katon W, Delaney K, Newton K. Urinary incontinence in US women: a population-based study. Arch Intern Med. 2005;165:537–42.

    Article  PubMed  Google Scholar 

  21. Minassian VA, Stewart WF, Wood CG. Urinary incontinence in Women: variation in prevalence estimates and risk factors. Obstet Gynecol. 2008;2:324–31.

    Article  Google Scholar 

  22. Minassian VA, Stewart WF, Hirsch A. Why do stress and urge incontinence co-occur much more often than expected? Int Urogynecol J Pelvic Floor Dysfunct. 2008;19:1429–40.

    Article  PubMed  Google Scholar 

  23. Minassian VA, Yan XS, Pitcavage J, Stewart WF. Mixed incontinence masked as stress induced urgency urinary incontinence. J Urol. 2016;196:1190–5.

    Article  PubMed  Google Scholar 

  24. Stewart WF, Minassian VA, Hirsch A, Lerch V, Kolodner K, Dilley A. Predictors of variability in urinary incontinence and overactive bladder. Neurourol Urodyn. 2010;29:328–35.

    CAS  PubMed  Google Scholar 

  25. Townsend MK, Danforth KN, Lifford KL, et al. Incidence and remission of urinary incontinence in middle-aged women. Am J Obstet Gynecol. 2007;197:167.e1–5.

    Article  Google Scholar 

  26. Jahanlu D, Qureshi SA, Hunskaar S. The Hordaland women’s cohort: a prospective cohort study of incontinence, other urinary tract symptoms and related health issues in middle-aged women. BMC Public Health. 2008;8:296.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Nygaard IE, Lemke JH. Urinary incontinence in rural older women: prevalence, incidence and remission. J Am Geriatr Soc. 1996;44:1049–54.

    Article  CAS  PubMed  Google Scholar 

  28. Viktrup L, Lose G. Incidence and remission of lower urinary tract symptoms during 12 years after the first delivery: a cohort study. J Urol. 2008;180:992–7.

    Article  PubMed  Google Scholar 

  29. Komesu YM, Rogers RG, Schrader RM, Lewis CM. Incidence and remission or urinary incontinence in a community-based population of women ≥50 years. Int Urogynecol J. 2009;20:581–9.

    Article  Google Scholar 

  30. Samuelsson EC, Victor FT, Svardsudd KF. Five-year incidence and remission rates of female urinary incontinence in a Swedish population less than 65 years old. Am J Obstet Gynecol. 2000;183:568–74.

    Article  CAS  PubMed  Google Scholar 

  31. Waetjen LE, Liao S, Johnson WO, et al. Factors associated with prevalent and incident urinary incontinence in a cohort of midlife women: a longitudinal analysis of data: study of women’s health across the nation. Am J Epidemiol. 2007;165:309–18.

    Article  PubMed  Google Scholar 

  32. Stewart WF, Hirsh AG, Kirchner HL, Clarke DN, Litchtenfeld MJ, Minassian VA. Urinary incontinence incidence: quantitative meta-analysis of factors that explain variation. J Urol. 2014;191:996–1002.

    Article  PubMed  Google Scholar 

  33. Legendre G, Ringa V, Panjo H, Zins M, Fritel X. Incidence and remission of urinary incontinence at midlife: a cohort study. BJOG. 2015;122:816–24.

    Article  CAS  PubMed  Google Scholar 

  34. Coyne KS, Zhou Z, Thompson C, Versi E. The impact on health-related quality of life of stress, urge and mixed urinary incontinence. BJU Int. 2003;92:731–5.

    Article  CAS  PubMed  Google Scholar 

  35. Frick AC, Huang AJ, Van den Eeden SK, Knight SK, Creasman JM, Yang J, et al. Mixed urinary incontinence: greater impact on quality of life. J Urol. 2009;182:596–600.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Minassian VA, Devore E, Hagan K, Grodstein F. Severity of urinary incontinence and effect on quality of life in women by incontinence type. Obstet Gynecol. 2013;121:1083–90.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Nygaard IE, Heit M. Stress urinary incontinence. Obstet Gynecol. 2004;104:607–20.

    Article  PubMed  Google Scholar 

  38. Milley PS, Nichols DH. The relationship between the pubo-urethral ligaments and the urogenital diaphragm in the human female. Anat Rec. 1971;170:281–3.

    Article  CAS  PubMed  Google Scholar 

  39. DeLancey JO. Structural support of the urethra as it relates to stress urinary incontinence: the hammock hypothesis. Am J Obstet Gynecol. 1994;170:1713–20.

    Article  CAS  PubMed  Google Scholar 

  40. Petros PE, Ulmsten UI. An integral theory of female urinary incontinence. Experimental and clinical considerations. Acta Obstet Gynecol Scand Suppl. 1990;153:7–31.

    Article  CAS  PubMed  Google Scholar 

  41. Petros PE, Woodman PJ. The integral theory of continence. Int Urogynecol J Pelvic Floor Dysfunct. 2008;19:35–40.

    Article  PubMed  Google Scholar 

  42. Delancey JO. Why do women have stress urinary incontinence. Neurourol Urodyn. 2010;29 Suppl 1:S13–7.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Abrams P, Wein A. Introduction to the overactive bladder: from basic science to clinical management. Urology. 1997;50(Suppl 6A):1–3.

    Article  Google Scholar 

  44. Freeman RM, Adekanmi OA. Overactive bladder. Best Pract Res Clin Obstet Gynaecol. 2005;19:829–41.

    Article  CAS  PubMed  Google Scholar 

  45. Meng E, Lin WY, Lee WC, Chuang YC. Pathophysiology of overactive bladder. Low Urin Tract Symptoms. 2012;4 (Suppl 1):48–55.

    Article  CAS  PubMed  Google Scholar 

  46. Bradley WE. Cerebro-cortical innervation of the urinary bladder. Tohoku J Exp Med. 1980;131:7–13.

    Article  CAS  PubMed  Google Scholar 

  47. Anderson JT, Bradley WE. Bladder and urethral innervation in multiple sclerosis. Br J Urol. 1976;48:239–43.

    Article  CAS  PubMed  Google Scholar 

  48. de Groat WC. A neurologic basis for the overactive bladder. Urology. 1997;50(Suppl 6A):36–52.

    Article  PubMed  Google Scholar 

  49. Sibley GN. Developments in our understanding of detrusor instability. Br J Urol. 1997;80 Suppl 1:54–61.

    PubMed  Google Scholar 

  50. Norgaard JP, van Gool JD, Hjalmas K, Djurhuus JC, Hellstrom AL. Standardization and definitions in lower urinary tract dysfunction in children. International Children’s Continence Society. Br J Urol. 1998;81:1–16.

    Article  PubMed  Google Scholar 

  51. Petros PE, Ulmsten U. Bladder instability in women: a premature activation of the micturition reflex. Neurourol Urodyn. 1993;12:235–9.

    Article  CAS  PubMed  Google Scholar 

  52. Bump RC, Norton PA, Zinner NR, Yalcin I, Duloxetine Urinary Incontinence Study Group. Mixed urinary incontinence symptoms: urodynamic findings, incontinence severity, and treatment response. Obstet Gynecol. 2003;102:76–83.

    PubMed  Google Scholar 

  53. Brubaker L, Stoddard A, Richter H, Zimmern P, Moalli P, Kraus SR, et al. Mixed incontinence: comparing definitions in women having stress incontinence surgery. Neurourol Urodyn. 2009;28:268–73.

    Article  PubMed  PubMed Central  Google Scholar 

  54. Brubaker L, Lukacz ES, Burgio K, Zimmern P, Norton P, Leng W, et al. Mixed incontinence: comparing definitions in non-surgical patients. Neurourol Urodyn. 2011;30:47–51.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Dooley Y, Lowenstein L, Kenton K, FitzGerald M, Brubaker L. Mixed incontinence is more bothersome than pure incontinence subtypes. Int Urogynecol J Pelvic Floor Dysfunct. 2008;19:1359–62.

    Article  PubMed  Google Scholar 

  56. Landefeld CS, Bowers BJ, Feld AD, Hartmann KE, Hoffman E, Ingber MJ, et al. National institutes of health state-of-the-science conference statement: prevention of fecal and urinary incontinence in adults. Ann Intern Med. 2008;148:449–58.

    Article  PubMed  Google Scholar 

  57. DeLancey JO. Current status of the subspecialty of female pelvic medicine and reconstructive surgery. Am J Obstet Gynecol. 2010;202:658.e1–4.

    Article  Google Scholar 

  58. Tähtinen RM, Cartwright R, Tsui JF, Aaltonen RL, Aoki Y, Cárdenas JL, et al. Long-term impact of mode of delivery on stress urinary incontinence and urgency urinary incontinence: a systematic review and meta-analysis. Eur Urol. 2016;70:148–58.

    Article  PubMed  PubMed Central  Google Scholar 

  59. Rortveit G, Hannestad YS, Daltveit AK, Hunskaar S. Age- and type-dependent effects of parity on urinary incontinence: the Norwegian EPINCONT study. Obstet Gynecol. 2001;98:1004–10.

    CAS  PubMed  Google Scholar 

  60. Townsend MK, Curhan GC, Resnick NM, Grodstein F. The incidence of urinary incontinence across Asian, black, and white women in the United States. Am J Obstet Gynecol. 2010;202:378.e1–7.

    Article  Google Scholar 

  61. Graham CA, Mallett VT. Race as a predictor of urinary incontinence and pelvic organ prolapse. Am J Obstet Gynecol. 2001;185:116–20.

    Article  CAS  PubMed  Google Scholar 

  62. Lukacz ES, Lawrence JM, Contreras R, Nager CW, Luber KM. Parity, mode of delivery, and pelvic floor disorders. Obstet Gynecol. 2006;107:1253–60.

    Article  PubMed  Google Scholar 

  63. Rortveit G, Daltveit AK, Hannestad YS, Hunskaar S, Norwegian EPINCONT study. Urinary incontinence after vaginal delivery or cesarean section. N Engl J Med. 2003;348:900–7.

    Article  PubMed  Google Scholar 

  64. Bazi T, Takahashi S, Ismail S, Bo K, Ruiz-Zapata AM, Duckett J, et al. Prevention of pelvic floor disorders: International urogynecological association research and development committee opinion. Int Urogynecol J. 2016;27:1785–95.

    Article  PubMed  Google Scholar 

  65. Hirsch AG, Minassian VA, Dilley A, Sartorius J, Stewart WF. Parity is not associated with urgency with or without urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct. 2010;21:1095–1102.

    Article  Google Scholar 

  66. Townsend MK, Danforth KN, Rosner B, Curhan GC, Resnick NM, Grodstein F. Body mass index, weight gain, and incident urinary incontinence in middle-aged women. Obstet Gynecol. 2007;110:346–53.

    Article  PubMed  Google Scholar 

  67. Hannestad YS, Rortveit G, Daltveit AK, Hunskaar S. Are smoking and other lifestyle factors associated with female urinary incontinence? The Norwegian EPINCONT study. BJOG. 2003;110:247–54.

    Article  PubMed  Google Scholar 

  68. Wesnes SL. Weight and urinary incontinence: the missing links. Int Urogynecol J. 2014;25:725–9.

    Article  PubMed  Google Scholar 

  69. Cummings JM, Rodning CB. Urinary stress incontinence among obese women: review of pathophysiology therapy. Int Urogynecol J Pelvic Floor Dysfunct. 2000;11:41–4.

    Article  CAS  PubMed  Google Scholar 

  70. Lawrence JM, Lukacz ES, Liu IL, Nager CW, Luber KM. Pelvic floor disorders, diabetes, and obesity in women: findings from the Kaiser Permanente Continence Associated Risk Epidemiology Study. Diabetes Care. 2007;30:2536–41.

    Article  PubMed  Google Scholar 

  71. Ebbesen MH, Hannestad YS, Midthjell K, Hunskaar S. Diabetes and urinary incontinence—prevalence data from Norway. Acta Obstet Gynecol Scand. 2007;86:1256–62.

    Article  PubMed  Google Scholar 

  72. Yamaguchi C, Sakakibara R, Uchiyama T, Yamamoto T, Ito T, Liu Z, et al. Overactive bladder in diabetes: a peripheral or central mechanism? Neurourol Urodyn. 2007;26:807–13.

    Article  PubMed  Google Scholar 

  73. Bump RC, Norton PA. Epidemiology and natural history of pelvic floor dysfunction. Obstet Gynecol Clin N Am. 1998;25:723–46.

    Article  CAS  Google Scholar 

  74. Albo ME, Richter HE, Brubaker L, Norton P, Kraus SR, Zimmern PE, et al. Burch colposuspension versus fascial sling to reduce urinary stress incontinence. N Engl J Med. 2007;356:2143–55.

    Article  CAS  PubMed  Google Scholar 

  75. Troko J, Bach F, Toozs-Hobson P. Predicting urinary incontinence in women in later life: a systematic review. Maturitas. 2016;94:110–6.

    Article  PubMed  Google Scholar 

  76. Subak LL, Richter HE, Hunskaar S. Obesity and urinary incontinence: epidemiology and clinical research update. J Urol. 2009;182(6 Suppl):S2–7.

    Article  PubMed  PubMed Central  Google Scholar 

  77. Elia G, Bergman J, Dye TD. Familial incidence of urinary incontinence. Am J Obstet Gynecol. 2002;187:53–5.

    Article  PubMed  Google Scholar 

  78. Buchsbaum GM, Duecy EE, Kerr LA, Huang LS, Guzick DS. Urinary incontinence in nulliparous women and their parous sisters. Obstet Gynecol. 2005;106:1253–8.

    Article  PubMed  Google Scholar 

  79. Hannestad YS, Lie RT, Rortveit G, Hunskaar S. Familial risk of urinary incontinence in women: population based cross sectional study. BMJ. 2004;329:889–91.

    Article  PubMed  PubMed Central  Google Scholar 

  80. Nguyen A, Aschkenazi SO, Sand PK, et al. Nongenetic factors associated with stress urinary incontinence. Obstet Gynecol. 2011;117(2 Pt 1):251–5.

    Article  PubMed  Google Scholar 

  81. Rohr G, Kragstrup J, Gaist D, Christensen K. Genetic and environmental influences on urinary incontinence: a Danish population-based twin study of middle-aged and elderly women. Acta Obstet Gynecol Scand. 2004;83:978–82.

    Article  PubMed  Google Scholar 

  82. Wennberg A, Altman D, Lundholm C, et al. Genetic influences are important for most but not all lower urinary tract symptoms: a population-based survey in a cohort of adult Swedish twins. Eur Urol. 2011;59:1032–8.

    Article  PubMed  PubMed Central  Google Scholar 

  83. Cartwright R, Kirby AC, Tikkinen KA, Mangera A, Thiagamoorthy G, Rajan P, et al. Systematic review and metaanalysis of genetic association studies of urinary symptoms and prolapse in women. Am J Obstet Gynecol. 2015;212:199.e1–24.

    Article  CAS  Google Scholar 

  84. Eiberg H, Shaumburg H, Von Gontard A, Rittig S. Linkage study of a large Danish 4-generation family with urge incontinence and nocturnal enuresis. J Urol. 2001;166:2401–3.

    Article  CAS  PubMed  Google Scholar 

  85. Norton P, Milsom I. Genetics and the lower urinary tract. Neurourol Urodyn. 2010;29:609–11.

    Article  PubMed  Google Scholar 

  86. McKenzie P, Rohozinski J, Badlani G. Genetic influences on stress urinary incontinence. Curr Opin Urol. 2010;20:291–5.

    Article  PubMed  Google Scholar 

  87. Skorupski P, Krol J, Starega J, Adamiak A, Jankiewicz K, Rechberger T. An alpha-1 chain of type I collagen Sp1-binding site polymorphism in women suffering from stress urinary incontinence. Am J Obstet Gynecol. 2006;194:346–50.

    Article  CAS  PubMed  Google Scholar 

  88. Wen Y, Man WC, Sokol ER, Polan ML, Chen BH. Is alpha2-macroglobulin important in female stress urinary incontinence? Hum Reprod. 2008;23:387–93.

    Article  CAS  PubMed  Google Scholar 

  89. Allen-Brady K, Norton PA, Farnham JM, Teerlink C, Cannon-Albright LA. Significant linkage evidence for a predisposition gene for pelvic floor disorders on chromosome 9q21. Am J Hum Genet. 2009;84:678–82.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  90. Richter HE, Whitehead N, Arya L, Ridgeway B, Allen-Brady K, Norton P, et al. Genetic contributions to urgency urinary incontinence in women. J Urol. 2015;193:2020–7.

    Article  PubMed  Google Scholar 

  91. Thomas-White K, Brady M, Wolfe AJ, Mueller ER. The bladder is not sterile: history and current discoveries on the urinary microbiome. Curr Bladder Dysfunct Rep. 2016;11:18–24.

    Article  PubMed  PubMed Central  Google Scholar 

  92. Schneeweiss J, Koch M, Umek W. The human urinary microbiome and how it relates to urogynecology. Int Urogynecol J. 2016;27:1307–12.

    Article  PubMed  Google Scholar 

  93. Pearce MM, Hilt EE, Rosenfeld AB, Zilliox MJ, Thomas-White K, Fok C, et al. The female urinary microbiome: a comparison of women with and without urgency urinary incontinence. MBio. 2014;5:e01283-14.

    Article  PubMed  PubMed Central  Google Scholar 

  94. Thomas-White KJ, Hilt EE, Fok C, Pearce MM, Mueller ER, Kliethermes S, et al. Incontinence medication response relates to the female urinary microbiota. Int Urogynecol J. 2016;27:723–33.

    Article  PubMed  Google Scholar 

  95. Koch M, Mitulovic G, Hanzal E, Umek W, Seyfert S, Mohr T, et al. Urinary proteomic pattern in female stress urinary incontinence: a pilot study. Int Urogynecol J. 2016;27:1729–34.

    Article  PubMed  PubMed Central  Google Scholar 

  96. Minassian VA, Yan X, Lichtenfeld MJ, Sun H, Stewart WF. The iceberg of health care utilization in women with urinary incontinence. Int Urogynecol J. 2012;23:1087–93.

    Article  PubMed  PubMed Central  Google Scholar 

  97. Myers DL. Female mixed urinary incontinence: a clinical review. JAMA. 2014;311:2007–14.

  98. Scotti RJ, Angell G, Flora R, Greston WM. Antecedent history as a predictor of surgical cure of urgency symptoms in mixed incontinence. Obstet Gynecol. 1998;91:51–4.

    Article  CAS  PubMed  Google Scholar 

  99. Holmgren C, Nilsson S, Lanner L, Hellberg D. Long-term results with tension-free vaginal tape on mixed and stress urinary incontinence. Obstet Gynecol. 2005;106:38–43.

    Article  PubMed  Google Scholar 

  100. Sung VW, Borello-France D, Dunivan G, Gantz M, Lukacz ES, Moalli P, et al. Methods for a multicenter randomized trial for mixed urinary incontinence: rationale and patient-centeredness of the ESTEEM trial. Int Urogynecol J. 2016;27:1479–90.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Brigham and Women’s Hospital, Boston, MA, USA

    Vatché A. Minassian

  2. Department of OB/GYN, 75 Francis Street, Boston, MA, 02115, USA

    Vatché A. Minassian

  3. American University of Beirut, Beirut, Lebanon

    Tony Bazi

  4. Sutter Health System, Walnut Creek, CA, USA

    Walter F. Stewart

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  1. Vatché A. Minassian
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Correspondence to Vatché A. Minassian.

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Minassian, V.A., Bazi, T. & Stewart, W.F. Clinical epidemiological insights into urinary incontinence. Int Urogynecol J 28, 687–696 (2017). https://doi.org/10.1007/s00192-017-3314-7

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