A B O U T U S
The UCSF Women's Continence Center conducts research to further understand the causes, diagnoses and treatments of urinary incontinence in women. These studies cannot exist without the assistance of women like you. Many of these studies lead to increasing the medical community's understanding of women's health.
To learn more or to participate in our research studies, visit Our Research Activities link. You can also contact us at the phone number below.
Highlights of our research include:
Urinary Incontinence Linked to Falls, Fractures
Urinary incontinence, falls and fractures are common health problems in later life, particularly in women. The symptoms associated with urinary incontinence such as frequent urination, a sense of urgency to urinate or rushing to the bathroom to avoid incontinent episodes, may increase the risk of falls and subsequent fractures. Dr. Jeanette Brown, director of the UCSF Women's Continence Center, conducted a study to research this relationship.
Over 6,000 women participated in the study. The study found that weekly or more frequent urge incontinence independently increased the risk of falls by 26 percent and the risk of fractures by 34 percent. Women with daily urge incontinence are at greatest risk. Stress incontinence was not associated with risk of falls or fractures.
Diagnosing and treating urge incontinence may be an effective way to reduce the risk of falls and fractures among women. Behavioral and drug therapies have shown that treatment of urge incontinence also leads to less frequent and urgent trips to the bathroom, therefore decreasing risk of falls and fractures. Environmental modifications such as a bedside commode for women with frequent nighttime incontinence also may decrease the risk of falls and fractures.
More than 600,000 women have hysterectomies each year in the United States, making this the second most common major surgical procedure after Caesarean section. By age 60, about 40 percent of women in the United States have had a hysterectomy. Nearly 90 percent of hysterectomies are done for benign symptomatic disorders such as uterine fibroids, vaginal bleeding, pelvic pain and pelvic organ prolapse.
Hysterectomy may lead to damage to the pelvic nerves or pelvic support structures that increases risk of urinary incontinence. Dr. Jeanette Brown, director of the UCSF Women's Continence Center, performed a meta-analysis — a systematic review of the literature — to determine if urinary incontinence might be a long-term consequence of hysterectomy.
Brown analyzed the results of 12 other studies on this topic. The data indicated that the odds of developing urinary incontinence after hysterectomy were about 40 percent higher than for women who had not undergone a hysterectomy. However, since urinary incontinence may not develop for many years after hysterectomy surgery, the study data were analyzed by age of participant.
After age 60, the odds of developing urinary incontinence were about 60 percent higher for women who had had a hysterectomy. These findings indicate that it is important for health care providers to counsel their patients considering hysterectomy about the long-term risk of urinary incontinence that may result from this surgery.
Dr. Jeanette Brown, director of the UCSF Women's Continence Center, was involved with a study to determine if postmenopausal hormone therapy improves the severity of urinary incontinence. Questions about incontinence and voiding frequency were added to an ongoing, randomized, blinded clinical trial of the effect of hormone therapy among over 2,700 postmenopausal women under 80 years old.
Study participants were randomly assigned to estrogen therapy or placebo (sugar pill) and followed for an average of 4.1 years. Severity of incontinence was classified as improved (if there was a decrease of at least two episodes per week), unchanged and worsened (if there was an increase of at least two episodes per week).
The study found that continence improved in more women taking the placebo than those taking the estrogen therapy. Additionally, for women whose condition worsened, those taking the estrogen actually experienced more problems than those taking the placebo. The results indicated that daily oral estrogen therapy was associated with worsening urinary incontinence in older postmenopausal women with weekly incontinence and that estrogen therapy should not be a recommended treatment.
Dr. Leslee Subak, one of the UCSF Women's Continence Center doctors, conducted a study to evaluate the effect weight reduction has on incontinence in moderately obese women. The study included 10 women who were moderately overweight and had over 10 incontinent episodes per week.
The study demonstrated an association between weight reduction and improved urinary continence.
Women participating in the study who achieved a weight loss of more than 5 percent had a more than 50 percent reduction in incontinence frequency, compared to the women who had less weight loss. Weight reduction should be considered as part of non-surgical therapy for incontinence for moderately obese women.
Further research is being conducted with additional women to evaluate the effect of weight reduction on incontinence and to identify patient and disease characteristics that predict improvement in urinary continence following weight loss.
Dr. Jeanette Brown is conducting a study to determine the independent associations between specific childbirth variables, hysterectomy, hormone use and subsequent urinary incontinence. About 2,100 women will be surveyed. From preliminary data, 73 percent of women have reported at least one episode of incontinence in the past 12 months or ever having been treated for incontinence.
The analysis of the results found a positive association between urinary incontinence and body mass, birthing a child vaginally and the use of estrogen. An association also was found between exposure to oxytocin during labor and incontinence in later life. At the completion of the study, more extensive analysis will be performed on these relationships.
The SANS device is a new medical technology that combines the concept of acupuncture with the medical concept of neuromodulation.
It was invented by Dr. Marshall Stoller, a professor of urology at UCSF, and received federal Food and Drug Administration approval in February 2000 for use with patients who have severe urge incontinence.
Treatment involves placing a fine needle into the skin of the ankle region. Both the nerves supplying sensation to the ankle and the nerves registering bladder symptoms and sensation derive from a common origin at the level of the lower spinal cord. It has been observed that a pulsing low frequency electrical stimulus can "reset" the misfiring nerves that send signals of urinary urgency, frequency, and bladder discomfort back to the brain.
This treatment is most appropriate for women with symptoms that are not responding to bladder training or medication, or those women who are truly unable to tolerate the side effects of medication.
Initial device testing takes place during an office consultation. The physician places the sterile fine needle into the soft tissue around the ankle. The needle is connected to a low frequency electrical stimulation device, which can be adjusted to achieve the desired effect.
The SANS device is used once a week, in 30-minute office sessions. After this initial period, the treatment schedule is tailored to the patient's needs.
For patients who achieve significant symptom improvement with this device, the hope is, in the near future, to implant a permanent device under the ankle skin. This permanent device is currently undergoing clinical trials in the United States and other countries. Dr. Wendy Leng, assistant professor of urology, and co-director of the UCSF Women's Continence Center, will be the principal investigator for the upcoming clinical trial to evaluate permanent implantable SANS devices.
Edward Kim, MD
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