Female urinary incontinence: work ability, hysterectomy as a risk factor and efficacy of invasive treatments

Thesis event information

Date and time of the thesis defence

Place of the thesis defence

Oulu university hospital, lecture hall 4

Topic of the dissertation

Female urinary incontinence: work ability, hysterectomy as a risk factor and efficacy of invasive treatments

Doctoral candidate

Licentiate of Medicine Heini Salo

Faculty and unit

University of Oulu Graduate School, Faculty of Medicine, Research Unit of Clinical Medicine

Subject of study

Medicine

Opponent

Docent Maarit Mentula, HUS Helsinki University Hospital

Custos

Professor Terhi Piltonen, Oulu university hospital

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Female urinary incontinence: work ability, hysterectomy as a risk factor and efficacy of invasive treatments

Urinary incontinence (UI) is defined as the involuntary loss of urine experienced during the bladder storage phase, affecting up to 50% women. The main types of UI are stress urinary incontinence (SUI), urge urinary incontinence (UUI), and mixed urinary incontinence (MUI). Although UI has major physical, sexual, social, psychological, and economic impacts on women’s lives, research on the prevalence of UI, risk factors, effect on work ability, and efficacy of invasive treatment methods is contradictory or lacking.
The aims of this study were to investigate the prevalence of UI and the effect of hysterectomy on the risk of subsequent UI, and to assess the impact of UI on the work ability of middle-aged women. Furthermore, we examined the long-term efficacy of mid-urethral sling (MUS) operations, compared the subjective outcomes between the retropubic (TVT) and transobturator (TOT) procedures, and assessed the efficacy and safety of low-dose onabotulinumtoxin A in the treatment of female overactive bladder (OAB). The study population for Studies I and II consisted of the Northern Finland Birth Cohort 1966 (NFBC1966). For Study III, the study population comprised 100 women who had undergone an MUS operation, and the population for Study IV comprised a group of 94 women who underwent onabotulinumtoxin A treatment.
Our results showed that the prevalence of self-reported UI was multiple compared to diagnosis-based prevalence. Hysterectomy was not independently associated with an increased risk of any UI type. In addition, UI was associated with poor work ability among middle-aged women, with the highest risk in the urgency type. MUS surgery had good long-term efficacy, and the outcomes between the TVT and TOT procedures were similar after a 16-year follow-up. Finally, low-dose onabotulinumtoxin A injections had good effectiveness and a tolerable safety profile in the second-line treatment of female OAB.
Altogether, UI is a severely underrecognized condition. Invasive treatments for SUI and UUI are effective and essential to improve women’s quality of life, promote sustainable careers, and reduce costs to society. Women undergoing surgical procedures such as hysterectomy for benign reasons should be provided with appropriate information on the impact of surgery on future health in order to assess the benefits and safety in decision-making.
Last updated: 6.11.2024