Clinical epidemiological insights into urinary incontinence
Clinical epidemiological insights into urinary incontinence
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DOI：
10.1007/s00192-017-3314-7
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发表时间：
2017-05-01
影响因子：
1.8
通讯作者：
Stewart, Walter F.
中科院分区：
文献类型：
--
作者：
Minassian, Vatche A.;Bazi, Tony;Stewart, Walter F.
尿失禁（UI）是非常常见的和异质性的进展或预后知识有限的妇女。基于临床流行病学的证据有助于更好地了解UI的自然史。我们研究了UI定义及其亚型的挑战，其对生活质量和就医行为的影响。我们回顾了UI亚型的病理生理学和已知的危险因素，因为它们与我们目前对疾病状态的了解有关。最后，我们强调流行病学的作用，在这个过程中获得新的见解，提高知识，并将这些信息转化为临床practice.Stress UI是最常见的整体，但混合UI是最普遍的老年妇女。这三种UI亚型有一些共同的风险因素，还有一些是独特的，但我们对它们如何发展的理解仍然存在重大差距。虽然应激性UI的病理生理学已有所了解，但尿急性UI仍主要是特发性的，而混合性UI是研究最少且最复杂的亚型。此外，存在关于症状随时间推移的进展的有限信息，以及不成比例的UI寻求健康的行为。我们确定探索领域（例如，表观遗传学，尿微生物组），并提供新的见解，以更好地了解UI亚型之间的关系，并制定一个完整的构建UI的自然history.Future的流行病学策略，采用纵向研究设计可以发挥关键作用，更好地阐明争议的UI自然史及其亚型的病理生理学，从而改善临床护理。
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.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.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.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.