Urological Survey

VOIDING FUNCTION AND DYSFUNCTION, BLADDER PHYSIOLOGY ANDPHARMACOLOGY, AND FEMALE UROLOGY

Functional Impairment as a Risk Factor for Urinary Incontinence Among Older Americans

K. RAHRIG JENKINS AND N. H. FULTZ, Institute for Social Research and Institute for Research on Women andGender, University of Michigan, Ann Arbor, Michigan

Neurourol Urodyn, 24: 51–55, 2005

Aims: Using a large nationally representative sample of older Americans we investigate four domains offunctional impairment as possible risk factors for the subsequent development of urinary incontinence (UI)symptoms. Methods: Data from three waves (1993, 1995, 1998) of the Asset and Health Dynamics amongthe Oldest Old (AHEAD) survey were used to model the effects of functional impairment on the onset of UIsymptoms. Results: A greater number of serious chronic conditions and functional impairment in the lowerbody mobility domain increased the odds of the onset of mild UI (vs. remaining continent). Factors thatcontributed to greater odds of the onset of severe UI (vs. remaining continent) were older age, beingrepresented by a proxy respondent, and functional impairment in the strength domain. Conclusions:Understanding the possible relationship between functional impairment and UI is an important steptoward developing appropriate interventions for the prevention, treatment, or management of urine loss.

Editorial Comment: The authors recognize certain limitations to their study: (1) the type ofincontinence symptoms or the quantity lost per episode was not characterized, but I would betthat urgency incontinence showed a stronger correlation than effort related incontinence; (2)the data are based on respondents’ reports rather than on physical examination or medicalrecords; (3) other persistent urological or urogynecological conditions were not characterizedor considered. Nevertheless, the important point is that pharmacological agents alone in olderAmericans are not apt to produce the type of beneficial result without attention to the preven-tion, amelioration or improvement of functional impairments that, very simply, prevent pa-tients from getting to the bathroom when they feel the urge to void.

Alan J. Wein, M.D.

Collagen Synthesis is Not Altered in Women With Stress Urinary Incontinence

Y. CHEN, M. DESAUTEL, A. ANDERSON, G. BADLANI AND L. KUSHNER, Department of Urology, Long IslandJewish Medical Center and Research Institute, North Shore-Long Island Jewish Health System, New HydePark, New York

Neurourol Urodyn, 23: 367–373, 2004

Aims: The objective of this study was to demonstrate that weakened pelvic floor support of the lowergenitourinary tract in women with stress urinary incontinence (SUI) is due, in part, to decreased collagensynthesis and secretion and/or an altered ratio of collagen III/I synthesis by the fibroblasts of the endopelvicfascia and skin compared to that of women without evidence of pelvic floor weakening. Methods: Endopel-vic fascia and skin biopsies were obtained from women with SUI (n � 14) and women without evidence ofSUI or genital prolapse (n � 12). Fibroblast cultures established from the biopsies were incubated with3H-proline in medium containing ascorbic acid for 3 hr. Conditioned medium was collected and cells wereharvested. The radiolabeled collagens were precipitated and digested with collagenase. The collagensynthesized (as a percent of total protein) was determined. Collagen �1(III) was separated from colla-gen �1(I) and �2(I) by interrupted SDS-PAGE and the amount of 3H-proline in each band was determined.Results: Collagen synthesis, expressed as percent of total protein synthesis, was not significantly differentbetween fibroblasts obtained from women with or without SUI. The mean of collagen III/I synthesized infibroblasts was not significantly different between fibroblasts obtained from women with or without SUI.Conclusions: These data suggest that the lower collagen content in the endopelvic fascia and skin of womenwith SUI is not due to reduced collagen synthesis or selective reduction in synthesis of either collagen I orcollagen III, compared to women without pelvic floor weakening.

0022-5347/05/1744-1349/0 Vol. 174, 1349–1355, October 2005THE JOURNAL OF UROLOGY® Printed in U.S.A.Copyright © 2005 by AMERICAN UROLOGICAL ASSOCIATION DOI: 10.1097/01.ju.0000177562.84743.81

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