Natural History of Stress, Urge and Mixed Urinary Incontinence in Women

描述（由申请人提供）：尿失禁（UI）非常普遍，影响所有年龄段的女性，对生活质量产生重大影响。压力UI（即运动时尿量减少）的患病率在中年达到峰值，然后下降。成年女性患病率为13%。冲动（即排尿减少，伴有强烈排尿欲望）和混合（压力和冲动）UI的患病率随年龄增加而增加，患病率估计分别为5%和11%。重要的是，如果假设纯粹的压力和纯粹的冲动UI是独立的，那么混合UI的患病率比预期的要普遍得多。预期（E）共现率为0.65%（0.13*0.05 = 0.0065），而观察到的（O）共现率为11%。应用程序的目的是了解为什么压力和敦促UI共同出现的频率比预期的要高得多。我们建议测试三种可能的模型的有效性。责任模型假定一种UI亚型的存在增加了另一种亚型发作的可能性，或者在混合UI的患者中，任一亚型的缓解率最低。另一种解释是，混合UI比纯粹的压力或冲动UI与更持久和更频繁的症状相关。在这个严重程度模型中，患有混合UI的女性更有可能在任何给定的一天表现出UI症状（即，更有可能在横截面处被检测为活动情况）而不是它们的纯应力或纯冲动对应物，因为它们固有地具有更严重的状况。第三种解释是，两种不同情况下共同的风险因素可能会导致比预期更频繁的共同发生。常见的压力和敦促UI的风险因素包括肥胖，产次，激素替代疗法，脱垂等。我们建议进行一项为期4年的纵向研究，以：1）确定UI亚型的发病率和缓解率的个体或复合效应是否解释了混合性UI的过度流行; 2）确定与单纯压力性或单纯急迫性UI病例相比，混合性UI的失禁症状表达是否更频繁和持久。在纵向研究中，我们还提出了一个嵌套的病例对照研究与风险因素的综合评价，以确定是否共同的风险因素压力和敦促UI解释这两个UI亚型的过度共同发生。了解每个模型对UI亚型患病率的相对影响将有助于解释UI亚型的病因和预后，我们认为这些信息与临床护理直接相关。 公共卫生宣传拟议的项目将增加我们对妇女尿失禁自然史的了解，包括压力性、急迫性和混合性尿失禁病例的发病率、缓解率和转化率。此外，它将导致更好地了解的关系的危险因素的演变失禁亚型。

DESCRIPTION (provided by applicant): Urinary incontinence (UI) is highly prevalent, affecting women of all ages with significant impact on quality of life. Prevalence of stress UI (i.e. loss of urine on exertion) peaks in midlife, and then declines thereafter. The adult female prevalence is 13%. Prevalence of urge (i.e. loss of urine with a strong desire to urinate) and mixed (stress and urge) UI increase with age with prevalence estimates of 5% and 11%, respectively. Importantly, prevalence of mixed UI is far more common than expected if pure stress and pure urge UI are assumed to be independent. The expected (E) co-occurrence is 0.65% (0.13*0.05 = 0.0065), compared to an observed (O) co-occurrence of 11%. The purpose of the application is to understand why stress and urge UI co-occur substantially more often than expected. We propose to test the validity of three possible models. The liability model posits that the presence of one UI subtype increases the likelihood for onset of the other, or that remission of either subtype is lowest in those with mixed UI. An alternative explanation is that mixed UI is associated with more persistent and frequent symptoms than pure stress or urge UI. In this severity model, women with mixed UI are more likely to exhibit UI symptoms on any given day (i.e., more likely to be detected at cross-section as an active case) than their pure stress or pure urge counterparts, because they inherently have a more severe condition. A third explanation is that risk factors common to two different conditions can lead to co-occurrence more often than expected. Risk factors common to stress and urge UI include obesity, parity, hormone replacement therapy, prolapse and others. We propose a four- year longitudinal study to: 1) Determine if the individual or composite effect of incidence and remission of UI subtypes explains the excess prevalence of mixed UI; and 2) Determine if the expression of incontinence symptoms is more frequent and persistent for mixed UI compared to either pure stress or pure urge UI cases. Within the longitudinal study we also propose a nested case-control study with a comprehensive evaluation of risk factors to determine if risk factors common to both stress and urge UI explain the excess co-occurrence of these two UI subtypes. Understanding the relative influence of each model on prevalence of UI subtypes will help to explain etiology of UI subtypes and prognosis, information that we believe is directly relevant to clinical care. PUBLIC HEALTH REVELANCE The proposed project will increase our knowledge of the natural history of urinary incontinence in women including incidence, remission and transition rates among stress, urge and mixed urinary incontinence cases. Moreover, it will result in a better understanding of the relation of risk factors to the evolution of incontinence subtypes.